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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 564700047
Report Date: 07/01/2026
Date Signed: 07/01/2026 12:57:07 PM

Document Has Been Signed on 07/01/2026 12:57 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:MELOS HOME CAREFACILITY NUMBER:
564700047
ADMINISTRATOR/
DIRECTOR:		EDWIN OYASANFACILITY TYPE:
300
ADDRESS:1051 QUASAR CTTELEPHONE:
(805) 267-6865
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: CENSUS: DATE:
07/01/2026
Annual/RandomANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Edwin A Oyasan - DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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Enforcement Analyst (EA), Ryan Chan, with the Home Care Services Branch (HCSB) conducted a virtual visit for the purpose of a biennial inspection, EA met with designee Edwin A Oyasan. The proper posting of business hours and license was observed during the virtual tour of the facility.

During the inspection, EA reviewed personnel records for Home Care Aides (HCA) including fingerprint status', registry status', tuberculosis (TB), and required training. The Home Care Organization’s (HCO’s) business records were also reviewed during the visit including the insurance requirements. Upon completion of the file review EA discussed the findings of the inspection with the designee and informed him of the deficiencies found and explained they would be noted on the 809D. EA advised HCAs without proof of negative tb test are not to be with clients.

An exit interview was conducted, a copy of this report and appeal rights were provided to the designee via email.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2026
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 07/01/2026 12:57 PM - It Cannot Be Edited


Created By: Ryan Chan On 07/01/2026 at 12:20 PM
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: MELOS HOME CARE
FACILITY NUMBER: 564700047

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2026
Section Cited
1796.45(a)
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1796.45(a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.
This requirement is not met as evidenced by:
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Based on records reviewed licensee did not ensure home care aide (HCA) staff # S1 submitted proof of negative tb test prior to being placed with clients which poses an immediate risk to the health and safety of clients 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2026
LIC809 (FAS) - (06/04)
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