<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700393
Report Date: 05/01/2024
Date Signed: 05/01/2024 01:18:39 PM

Document Has Been Signed on 05/01/2024 01:18 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:A PEACEFUL WAY HOME CAREFACILITY NUMBER:
194700393
ADMINISTRATOR/
DIRECTOR:		SUSIE TAPIAFACILITY TYPE:
300
ADDRESS:4000 PALOS VERDES DR N STE.100TELEPHONE:
(310) 377-3776
CITY:ROLLING HILLS ESTATESTATE: CAZIP CODE:
90274
CAPACITY: CENSUS: DATE:
05/01/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Brianne Genz, DesigneeTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Home Care Services Branch Analysts Mila Quinto and Ryan Chan arrived at the business office for a Biennial inspection visit. Upon arrival, the analysts met with designee, Brianne Genz. 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 the analyst discussed the findings of the inspection with the designee and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 1