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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 124700004
Report Date: 01/03/2024
Date Signed: 01/09/2024 12:06:45 PM


Document Has Been Signed on 01/09/2024 12:06 PM - 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:AGAPE HOME CAREFACILITY NUMBER:
124700004
ADMINISTRATOR:TRENT ZELANICKFACILITY TYPE:
300
ADDRESS:321 W WABASH AVETELEPHONE:
(707) 445-1212
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:CENSUS: DATE:
01/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Amy ZelanickTIME COMPLETED:
03:25 PM
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Home Care Services Branch (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil, arrived at the business office of Agape Home Care for a Case Management - Deficiencies Inspection on 1.3.2023 at approximately 2:00 PM.

Upon arrival, AGPA Vigil identified herself and was greeted by Designee, Amy Zelanick. 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 Designee and informed no discrepancies were found.

SUPERVISOR'S NAME: Wendy ScottTELEPHONE: (916) 862-3502
LICENSING EVALUATOR NAME: Megan VigilTELEPHONE: (916) 217-5737
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.

HCS809 (FAS) - (06/04)
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