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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700388
Report Date: 01/09/2026
Date Signed: 01/09/2026 04:52:38 PM

Document Has Been Signed on 01/09/2026 04:52 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:A PLACE AT HOME - ENCINITASFACILITY NUMBER:
374700388
ADMINISTRATOR/
DIRECTOR:		PEREZ-VAN VALZAH, JOSCELYNFACILITY TYPE:
300
ADDRESS:16885 W BERNARDO DR STE 118TELEPHONE:
(719) 922-5227
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: CENSUS: DATE:
01/09/2026
Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Joscelyn Perez-Van ValzahTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On January 9, 2026, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of A Place at Home Encinitas for the purpose of conducting a case management to address the violation discovered during a complaint investigation. Licensee arrived at approximately 3:00 PM. EA met with Designee Joscelyn Perez-Van Valzah to discuss the violation.

During interview, Designee Perez-Van Valzah identified two staff (staff #1 and Staff #2) as Home care Aides caring for a client. A subsequent review of relevant documents revealed that Licensee did not affiliate the staff to the Home Care Organization on the Home Care Aide Registry in violation of Health and Safety Chapter 13, Article 7, Section 1796.43(a). Licensee is being cited on the attached HCS809-D form.

Licensee was provided a copy of this report and HCS9058 Appeal rights form.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2026
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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Document Has Been Signed on 01/09/2026 04:52 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 01/09/2026 at 06:53 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: A PLACE AT HOME - ENCINITAS
FACILITY NUMBER: 374700388

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/12/2026
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 information provided by licensee it was discovered that Reference #1 and Reference #2 were not affiliated and cleared on the California Home Care Aide Registry prior to being allowed contact with a client, 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: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2026
LIC809 (FAS) - (06/04)
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