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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 104700015
Report Date: 01/08/2025
Date Signed: 01/15/2025 07:34:37 AM

Document Has Been Signed on 01/15/2025 07:34 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:IN HOME SERVICES, LLCFACILITY NUMBER:
104700015
ADMINISTRATOR/
DIRECTOR:		STEPHEN SIMMONSFACILITY TYPE:
300
ADDRESS:1673 LEWIS STTELEPHONE:
(559) 897-5161
CITY:KINGSBURGSTATE: CAZIP CODE:
93631
CAPACITY: CENSUS: DATE:
01/08/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Sarah SimmonsTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of In Home Services for a biennial inspection on 1/8/2025. Upon arrival, the HCSB analyst identified himself and was greeted by Sarah Simmons. 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 Sarah that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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