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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700381
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:07:48 PM

Document Has Been Signed on 12/03/2024 04:07 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:FAMILY MATTERS IN-HOME CARE LLCFACILITY NUMBER:
374700381
ADMINISTRATOR/
DIRECTOR:		JACOB LAFFENFACILITY TYPE:
300
ADDRESS:100 E SAN MARCOS BLVD STE400TELEPHONE:
(760) 909-2007
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: CENSUS: DATE:
12/03/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Carol FierroTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On December 3, 2024, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Family Matters in-Home Care San Diego, LLC for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Carol Fierro. 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. Designee provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. Ten employee files were reviewed.

Upon completion of the file review Analyst discussed the findings of the inspection with Designee and informed Designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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