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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700364
Report Date: 12/12/2024
Date Signed: 12/12/2024 04:02:39 PM

Document Has Been Signed on 12/12/2024 04:02 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:DELUXE CONCIERGE NURSING, INCFACILITY NUMBER:
374700364
ADMINISTRATOR/
DIRECTOR:		ANGELA MAIFACILITY TYPE:
300
ADDRESS:170 EUCALYPTUS AVETELEPHONE:
(760) 575-4331
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: CENSUS: DATE:
12/12/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Angela MaiTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On December 12, 2024, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Deluxe Concierge Nursing Inc for a POst Licensiing inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Licensee Angela Mai. 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. Licensee provided Analyst with proof of current professional liability policy, worker's compensation, and dishonesty bond. Licensee has no employees currently.

Upon completion of the file review Analyst discussed the findings of the inspection with Licensee and informed Licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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