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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700364
Report Date: 06/22/2026
Date Signed: 06/22/2026 03:30:59 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/22/2026 03:30 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:
06/22/2026
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Angela MaiTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Enforcement Analyst (EA), Adrian Mangina, with the Home Care Services Branch (HCSB) conducted an announced virtual visit for the purpose of a biennial inspection. The EA met with the licensee, Angela Mai. During virtual tour of the facility, Licensee stated that she has no clients and no employees. She stated that she is not currently operating and will allow the License to lapse next month.

During the inspection, the EA reviewed personnel records for licensee, the Home Care Organization’s (HCO’s) business records, including the insurance requirements.

During today’s visit, EA Mangina found the Home Care Organization (HCO) was in compliance and no deficiencies were cited.

An exit interview was conducted, a copy of this report, Home Care Organization Evaluation Report (HCS809), Appeal Rights (HCS9058) were provided to the licensee, Angela Mai, via email.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2026
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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