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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700062
Report Date: 10/17/2024
Date Signed: 10/17/2024 03:12:18 PM

Document Has Been Signed on 10/17/2024 03:12 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:HOME INSTEAD SENIOR CAREFACILITY NUMBER:
194700062
ADMINISTRATOR/
DIRECTOR:		DON PIERCEFACILITY TYPE:
300
ADDRESS:5500 E. ATHERTON ST.,STE 216TELEPHONE:
(562) 596-4884
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: CENSUS: DATE:
10/17/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Samantha Rhodes - HR CoordinatorTIME VISIT/
INSPECTION COMPLETED:
03:30 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 10/17/24 for a biennial inspection. Upon arrival,EA identified himself and was greeted by HR Coordinator Samantha Rhodes. The proper posting of business hours and license was observed. 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 Samantha Rhodes and informed her that no discrepancies were found.

EA Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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