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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700041
Report Date: 09/05/2023
Date Signed: 09/05/2023 12:06:29 PM

Document Has Been Signed on 09/05/2023 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:LIFELINE COMPANION SERVICES, INC.FACILITY NUMBER:
194700041
ADMINISTRATOR:KIM CABRERAFACILITY TYPE:
300
ADDRESS:3100 WEST BURBANK BLVDSTE104TELEPHONE:
(818) 557-6200
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: CENSUS: DATE:
09/05/2023
Required - 2 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kimberly CabreraTIME COMPLETED:
12:15 PM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Lifeline Companion Services, Inc on 9/5/2023 for a biennial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Kimberly Cabrera. 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 Kim and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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