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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700378
Report Date: 07/23/2025
Date Signed: 07/23/2025 12:08:38 PM

Document Has Been Signed on 07/23/2025 12:08 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:EUCALYPTUS HOME CARE LLCFACILITY NUMBER:
374700378
ADMINISTRATOR/
DIRECTOR:		JAMES DICKSONFACILITY TYPE:
300
ADDRESS:16950 VIA DE SANTA FE, STE 132TELEPHONE:
(858) 472-5912
CITY:RANCHO SANTA FESTATE: CAZIP CODE:
92067
CAPACITY: CENSUS: DATE:
07/23/2025
Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:James DicksonTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 7/23/25, Enforcement Analyst (EA) Adrian Mangina arrived the address above for the purpose of conducting a Case Management-deficiencies inspection, Upon Arrival EA was greeted by and granted entry into the office by Designee James Dickson. It had been reported that a client made an accusation against a caregiver. During the review of files following the incident, EA discovered that a Home Care Aide employed by the Home Care Organization was not Fingerprint cleared and not cleared on the Home Care Agency before having contact with clients as required.

Upon completion of the document review the analyst discussed the findings of the inspection with Designee. The Analyst informed the representative named above of the deficiencies found and explained they would be noted on the HCS809-D forms. In addition, the Licensee was provided a copy of the HCS9058 Appeal Rights form.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2025
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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Document Has Been Signed on 07/23/2025 12:08 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 07/23/2025 at 07:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: EUCALYPTUS HOME CARE LLC
FACILITY NUMBER: 374700378

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/24/2025
Section Cited
1796.23(a)
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FINGERPRINT REQUIREMENTS: (a) Each person initiating a background examination to be a registered home care aide shall submit their fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d).
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This requirement was not met as evidenced by: During the review of files on 7/23/25 Licensee was not able to provide proof that Reference #1 was fingerprint cleared before client contact, a finding which poses an immediate health and safety risk to persons in care
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Type A
07/24/2025
Section Cited
1796.43(a)
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EMPLOYEES, VOLUNTEERS, AND AFFILIATED HOME CARE AIDE REQUIREMENTS: Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients.
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This requirement was not met as evidenced by: During the review of files on 7/23/25 Licensee was not able to provide proof that Reference #1 was affiliated and cleared on the Home Care Aide Registry before client contact, a finding which poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2025
LIC809 (FAS) - (06/04)
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