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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 044700002
Report Date: 02/20/2024
Date Signed: 02/20/2024 01:17:11 PM

Document Has Been Signed on 02/20/2024 01:17 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:ADDUS HOMECAREFACILITY NUMBER:
044700002
ADMINISTRATOR:KELLY RESSLERFACILITY TYPE:
300
ADDRESS:196 COHASSET ROAD, STE. 270TELEPHONE:
(630) 296-3400
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY: CENSUS: DATE:
02/20/2024
Required - 2 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jordyn Balkin TIME COMPLETED:
01:30 PM
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Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of Addus Homecare for a Two-Year required Inspection on 2.20.2024 at approximately 12:00PM.

Upon arrival, AGPA Vigil identified herself and was greeted by Designee, Jordyn Balkin. 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 AGPA Vigil discussed the findings of the inspection with the Designee and informed no discrepancies were found. A copy of the report was provided with appeal rights. Exit interview was conducted.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2024
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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