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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 154700016
Report Date: 12/22/2021
Date Signed: 12/22/2021 10:15:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:BAKERSFIELD AGAPE IN HOME CARE, INC.FACILITY NUMBER:
154700016
ADMINISTRATOR:SANDRA MUTHFACILITY TYPE:
300
ADDRESS:4800 DISTRICT BLVD. STE ATELEPHONE:
(661) 835-0364
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:0CENSUS: DATE:
12/22/2021
TYPE OF VISIT:Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Sandy MuthTIME COMPLETED:
11:00 AM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Bakersfield Agape In Home Care on 12/22/2021. Upon arrival, the HCSB analyst identified himself and was greeted by Sandy Muth. 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 Sandy and informed the licensee that no discrepancies were found.
SUPERVISOR'S NAME: Cynthia TibbettsTELEPHONE: (916) 653-1524
LICENSING EVALUATOR NAME: Ruben PerezTELEPHONE: (916) 651-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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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