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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700120
Report Date: 03/05/2025
Date Signed: 03/05/2025 11:47:04 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/05/2025 11:47 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:BERGER, INC. DBA AVEANNA HEALTHCAREFACILITY NUMBER:
194700120
ADMINISTRATOR/
DIRECTOR:		SAUCEDO, DENISEFACILITY TYPE:
300
ADDRESS:1730 WEST CAMERON AVE. STE 120TELEPHONE:
(800) 974-1234
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY: CENSUS: DATE:
03/05/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Pauline Dominguez - Client CoordinatorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of BERGER, INC. DBA AVEANNA HEALTHCARE on 3/5/25 for a biennial inspection. Upon arrival, EA was greeted by Client Coordinator Pauline Dominguez. 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 Ms. Dominguez and informed her that no discrepancies were found.

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

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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