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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 014700098
Report Date: 06/24/2024
Date Signed: 06/24/2024 02:41:46 PM

Document Has Been Signed on 06/24/2024 02:41 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:NURSE NEXT DOORFACILITY NUMBER:
014700098
ADMINISTRATOR/
DIRECTOR:		AVALOS, LINDENFACILITY TYPE:
300
ADDRESS:6990 VILLAGE PARKWAY SUITE 206TELEPHONE:
(925) 640-9909
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: CENSUS: DATE:
06/24/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Designee - Lanita CuspardTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Home Care Services Branch (HCSB) Analyst, Todd Borcher, arrived at the business office of Nurse Next Door for a Two-Year Licensing inspection on June 24, 2024. Upon arrival, the Analyst identified himself and was greeted by Designee Lanita Cuspard. The proper posting of business hours and license was observed. The Analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the Analyst discussed the findings of the inspection with the Designee and informed Designee that no discrepancies were found. A copy of the report was provided with appeal rights. Exit interview was conducted.
LICENSING EVALUATOR NAME: Todd Borcher
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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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