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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 104700025
Report Date: 09/24/2024
Date Signed: 09/24/2024 09:44:24 AM

Document Has Been Signed on 09/24/2024 09:44 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:SENIOR HELPERSFACILITY NUMBER:
104700025
ADMINISTRATOR/
DIRECTOR:		MONCIVAIS, SABRINAFACILITY TYPE:
300
ADDRESS:450 S. MADERA AVE. STE. ETELEPHONE:
(559) 363-4545
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: CENSUS: DATE:
09/24/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Sabrina MoncivaisTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Senior Helpers on 9/24/2024. Upon arrival, the HCSB analyst identified himself and was greeted by Sabrina Moncivais. 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 Sabrina and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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