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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700287
Report Date: 02/19/2025
Date Signed: 02/19/2025 11:51:54 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/19/2025 11:51 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:MY PARENTS HOME LLCFACILITY NUMBER:
374700287
ADMINISTRATOR/
DIRECTOR:		TERRY, KATHYFACILITY TYPE:
300
ADDRESS:443 BLUEBERRY CIRCLETELEPHONE:
(949) 532-7879
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY: CENSUS: DATE:
02/19/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Kathy TerryTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On February 19, 2025, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of My Parents Home LLC for a Biennial inspection. The residence is on a military base and requires accompaniment from resident to enter. Upon arrival, the Enforcement Analyst was met by Owner Kathy Terry and escorted to premises. 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. Anylyst discussed best practices and file set up for success and provided links to statutes, Guardian, and Home Care Registry. Owner provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. HCO has no Home Care Aides and no clients.

Upon completion of the file review Analyst discussed the findings of the inspection with Ms. Terry and informed her that no discrepancies were found.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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