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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700154
Report Date: 05/21/2024
Date Signed: 05/21/2024 12:31:51 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/21/2024 12:31 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:AMADA SENIOR CAREFACILITY NUMBER:
194700154
ADMINISTRATOR/
DIRECTOR:		PEGUS, CYNDIFACILITY TYPE:
300
ADDRESS:3812 SEPULVEDA BLVD, SUITE 200TELEPHONE:
(310) 200-1899
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: CENSUS: DATE:
05/21/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:CYNDI PEGUS and SANDI GIDEONTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Home Care Services Bureau (HCSB) Analyst Ryan Chan and Mila Quinto arrived at the business office of Amada Senior Care for a biennial inspection. Upon arrival, analysts were greeted by Cyndi Pegus and Sandi Gideon. The proper posting of business hours and license was observed. The proof of insurance record was reviewed. The analysts were 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 Ms. Pegus and Ms. Gideon and informed them that no discrepancies were found.
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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