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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 074700182
Report Date: 08/26/2024
Date Signed: 09/16/2024 09:28:24 AM

Document Has Been Signed on 09/16/2024 09:28 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:ACASA SENIOR CAREFACILITY NUMBER:
074700182
ADMINISTRATOR/
DIRECTOR:		TIFFANY HOWARDFACILITY TYPE:
300
ADDRESS:4 TYLER CTTELEPHONE:
(843) 442-5693
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: CENSUS: DATE:
08/26/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Tiffany HowardTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Associate Government Program Analyst (AGPA) Megan Vigil, arrived at the business office of Acasa Senior Care for a post licensing inspection.

Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Tiffany Howard. 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 advised no deficiencies were found.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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