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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 074700012
Report Date: 05/23/2024
Date Signed: 05/23/2024 11:53:33 AM

Document Has Been Signed on 05/23/2024 11:53 AM - 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:AMAYA HOME CAREFACILITY NUMBER:
074700012
ADMINISTRATOR/
DIRECTOR:		MENDAROS, MICHAELFACILITY TYPE:
300
ADDRESS:4617 HIDDEN GLEN DRTELEPHONE:
(707) 334-2778
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: CENSUS: DATE:
05/23/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Michael MendarosTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of Amaya Home Care for a two-year required inspection.

Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Michael Mendaros. 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. A copy of the report was provided with appeal rights.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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