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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700027
Report Date: 05/26/2026
Date Signed: 05/28/2026 08:12:36 AM

Document Has Been Signed on 05/28/2026 08:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:HOME INSTEAD SENIOR CARE # 146FACILITY NUMBER:
374700027
ADMINISTRATOR/
DIRECTOR:		PAUL DZIUBANFACILITY TYPE:
300
ADDRESS:901 HACIENDA DR STE BTELEPHONE:
(760) 639-6472
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: CENSUS: DATE:
05/26/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Danielle TIME VISIT/
INSPECTION COMPLETED:
04:29 PM
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Home Care Services Branch (HCSB), Enforcement Analyst (EA) Adrian Mangina spoke to licensee Danielle Gosser to conduct a telephone pre-inspection interview. The licensee is due for a biennial visit and has agreed to a virtual visit with EA. The virtual visit is scheduled for June 8, at 9:00 AM via Microsoft Teams/FaceTime.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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