<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700252
Report Date: 01/29/2025
Date Signed: 01/29/2025 02:43:24 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/29/2025 02:43 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:SYNERGY HOME CARE OF NORTH COUNTYFACILITY NUMBER:
374700252
ADMINISTRATOR/
DIRECTOR:		BUTLER, JEBFACILITY TYPE:
300
ADDRESS:5857 OWENS AVENUE, SUITE 300TELEPHONE:
(760) 990-4289
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: CENSUS: DATE:
01/29/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Jeb ButlerTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On January 29, 2025 Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived
the business office of Synergy Home Care of North County for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Jeb Butler. Martha Butler participated by telephone. Analyst Mangina observed the proper posting of business hours and license. Analyst was provided an area in which the review of personnel and administrative files could be performed. Designee provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, an dishonesty bond are current. Ten employee files were reviewed.

Upon completion of the file review Analyst discussed the findings of the inspection with Designee Butler and informed Designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 1