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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700299
Report Date: 03/06/2026
Date Signed: 05/26/2026 09:30:27 AM

Document Has Been Signed on 05/26/2026 09:30 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:GOLDEN AGE CARE INCFACILITY NUMBER:
374700299
ADMINISTRATOR/
DIRECTOR:		VILLAGOMEZ, HARIMFACILITY TYPE:
300
ADDRESS:1115 TOBIAS DRTELEPHONE:
(619) 755-3854
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: CENSUS: DATE:
03/06/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:30 PM
MET WITH:Harim VillagomezTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Home Care Services Branch (HCSB), Enforcement Analyst (EA) Adrian Mangina
spoke to licensee Harim Villagomez 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 March 13th at 3:30 PM via Microsoft Teams.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2026
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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