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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 044700016
Report Date: 03/10/2025
Date Signed: 03/10/2025 02:26:45 PM

Document Has Been Signed on 03/10/2025 02:26 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:INTERIM HEALTHCARE PERSONAL CARE & SUPPORTFACILITY NUMBER:
044700016
ADMINISTRATOR/
DIRECTOR:		MICHELLE KELLYFACILITY TYPE:
300
ADDRESS:2060 TALBERT DR. #100TELEPHONE:
(530) 899-8777
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: CENSUS: DATE:
03/10/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee - Shelly KellyTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Home Care Services Branch (HCSB) Analyst, Todd Borcher, arrived at the business office of Interim Healthcare Personal Care & Support for a Two-Year Licensing inspection on March 10, 2025. Upon arrival, the Analyst identified himself and was greeted by licensee Shelly Kelly. 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 licensee and informed the licensee 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: 03/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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