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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 074700004
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:47:11 PM

Document Has Been Signed on 09/19/2024 02:47 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:J&M HOME CARE SERVICES, LLCFACILITY NUMBER:
074700004
ADMINISTRATOR/
DIRECTOR:		V.E. JENSENFACILITY TYPE:
300
ADDRESS:16 CROW CANYON COURT SUITE 200TELEPHONE:
(925) 552-6500
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: CENSUS: DATE:
09/19/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Vicki WildmanTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of J&M Home Care Services, LLC for a two-year required inspection.

Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Vicki Wildman. 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 Licensee and informed no discrepancies were found.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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