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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
124700004
Report Date:
01/03/2024
Date Signed:
04/25/2024 10:11:43 AM
Unsubstantiated
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES
,
744 P STREET, MS 09-14-90
SACRAMENTO
,
CA
95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2022
and conducted by Evaluator
Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER:
47-HC-20220328100539
FACILITY NAME:
AGAPE HOME CARE
FACILITY NUMBER:
124700004
ADMINISTRATOR:
TRENT ZELANICK
FACILITY TYPE:
300
ADDRESS:
321 W WABASH AVE
TELEPHONE:
(707) 445-1212
CITY:
EUREKA
STATE:
CA
ZIP CODE:
95501
CAPACITY:
CENSUS:
DATE:
01/03/2024
UNANNOUNCED
TIME BEGAN:
02:15 PM
MET WITH:
Amy Zelanick.
TIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME
:
Wendy Scott
LICENSING EVALUATOR NAME
:
Megan Vigil
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099
(FAS) - (06/04)
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