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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700245
Report Date: 07/09/2025
Date Signed: 07/09/2025 01:54:49 PM

Document Has Been Signed on 07/09/2025 01:54 PM - 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:AMAZING GRACE HOME HEALTH SERVICES LLCFACILITY NUMBER:
374700245
ADMINISTRATOR/
DIRECTOR:		ADIAO, MARIA SOCORROFACILITY TYPE:
300
ADDRESS:7798 GASTON DR.TELEPHONE:
(858) 349-3473
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: CENSUS: DATE:
07/09/2025
POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:unavalableTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On 7/925 at 9:00 AM, Enforcement Analyst A(EA) Adrian Mangina arrived at the address above to conduct an unannounced Plan of Correction Inspection of Amazing Grace Home Health Services for the citation issued 5/21/25. Enforcement Analyst (EA) Adrian Mangina arrived during posted business hours of 9:00 AM to 5:00 PM. Licensee was not present and did not answer the phone when called. This is the third missed or refused visit during business hours.

Licensee is advised that additional missed visits could result in consequences including revocation of the license.

Deficiencies cited on the attached HCS809-D form and emailed to Licensee along with a copy of the HCS9058 Appeal Rights form.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
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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Document Has Been Signed on 07/09/2025 01:54 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 07/09/2025 at 07:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: AMAZING GRACE HOME HEALTH SERVICES LLC
FACILITY NUMBER: 374700245

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2025
Section Cited
1796.53
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Authority to Visit HCOs : A duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter a home care organization during posted business hours, with or without advance notice, to secure compliance with, or to prevent a violation of, any provision of this chapter or any provision promulgated under this chapter.
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This requirement was not evidenced by: EA attempted to conduct a plan of Correction visit for the citation issued 5/21/25 but Licensee was not present during posted business hours and refused to return to Licensed address to allow EA to conduct records review, a finding which poses an immediate health and safety risk to persons in care.
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Type A
07/10/2025
Section Cited
1796.55(a)
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Violations:A home care organization that operates in violation of any requirement or obligation imposed by this chapter or any rule or regulation promulgated pursuant to this chapter may be subject to the fines levied or licensure action taken by the department as specified in this chapter.
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This requirement was not evidenced by: EA attempted to conduct a plan of Correction visit for the citation issued 5/21/25 but Licensee was unavailable during posted business hours and has thus far refused to provide records upon request on this and two previous occasions, a finding which poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
LIC809 (FAS) - (06/04)
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