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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700116
Report Date: 01/30/2024
Date Signed: 01/31/2024 08:31:18 AM

Document Has Been Signed on 01/31/2024 08:31 AM - 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:RIGHT AT HOME WEST LAFACILITY NUMBER:
194700116
ADMINISTRATOR:TIMOTHY PETLINFACILITY TYPE:
300
ADDRESS:1750 14TH STREET SUITE ATELEPHONE:
(310) 313-0600
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY: CENSUS: DATE:
01/30/2024
Required - 2 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Timothy PetlinTIME COMPLETED:
03:10 PM
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Home Care Services Branch (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil, arrived at the business office of Right at Home West LA for a Required Two Year Licensing Inspection on 1.30.2024 at approximately 2:30PM.

Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Timothy Petlin. 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 Licensee and informed no discrepancies were found.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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