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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 014700137
Report Date: 01/05/2022
Date Signed: 01/05/2022 12:03:20 PM

Document Has Been Signed on 01/05/2022 12:03 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:AFFINITY CARE GROUP LLCFACILITY NUMBER:
014700137
ADMINISTRATOR:DAVID LINGANFACILITY TYPE:
300
ADDRESS:1926 PARK ST STE 3TELEPHONE:
(888) 816-2813
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 0CENSUS: DATE:
01/05/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Joemercy LinganTIME COMPLETED:
12:45 PM
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti arrived at the business office of Affinity Care Group LLC on 1/5/2022. Upon arrival, the HCSB analyst identified himself and was greeted by Joemercy Lingan. 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 Joemercy and informed her that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2022
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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