Senior Care Records.

Home Care Organization Evaluation Report

Caregiver Provider, Canyon Lake10/30/2024Licence 334700114

Date signed10/30/2024 01:03:12 PM
The inspector’s account

On October 30,2024 Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Caregiver Provider fo the purpose of a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted Licensee, Jennifer Dain. Analyst Mangina observed the proper posting of business hours and license. The analyst was provided an area in which the review of personnel and administrative files could be performed. Licensee 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 the analyst discussed the findings of the inspection with the Licensee Jennifer Dain. 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.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction