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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700255
Report Date: 12/23/2024
Date Signed: 12/24/2024 07:01:16 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/24/2024 07:01 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:GENKI HOME CAREFACILITY NUMBER:
374700255
ADMINISTRATOR/
DIRECTOR:		KANEKO, EUGENEFACILITY TYPE:
300
ADDRESS:1260 THIRD AVETELEPHONE:
(858) 699-7020
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: CENSUS: DATE:
12/23/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Derek YaguraTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On December 23, 2024, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Genki Home Care for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Derek Yagura. Analyst Mangina observed the proper posting of business hours and license. The Analyst was provided an area in which the review of personnel and administrative files could be performed. Designee provided Analyst with proof of current professional liability policy, worker's compensation, and dishonesty bond. Ten employee files were reviewed.

Upon completion of the file review Analyst discussed the findings of the inspection with with Designee Yagura and informed Designee that no discrepancies were found. Designee was provided a copy of the report and HCS9058 Appeal Rights form.

LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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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