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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700052
Report Date: 04/29/2025
Date Signed: 04/29/2025 01:48:37 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/29/2025 01:48 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:JEDCONNET, LLC DBA HOME INSTEAD SENIOR CAREFACILITY NUMBER:
194700052
ADMINISTRATOR/
DIRECTOR:		CHANNTANZA FONTENOTFACILITY TYPE:
300
ADDRESS:5601 WEST SLAUSON AVE STE 255TELEPHONE:
(310) 645-8475
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY: CENSUS: DATE:
04/29/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Eric Carr - LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Home Instead Senior Care on 4/29/25 for a biennial inspection. EA met with licensee Eric Carr. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. EA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EA discussed the findings of the inspection with the licensee and informed him that no discrepancies were found.

EA Chan concluded the visit with an exit interview and provided a copy of this report to the licensee.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2025
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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