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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700442
Report Date: 09/06/2023
Date Signed: 09/14/2023 02:41:26 PM

Document Has Been Signed on 09/14/2023 02:41 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:CARENETLAFACILITY NUMBER:
194700442
ADMINISTRATOR:EDWARD DEVITTFACILITY TYPE:
300
ADDRESS:600 DEEP VALLEY DR STE DTELEPHONE:
(310) 393-1282
CITY:ROLLING HILLS ESTATESTATE: CAZIP CODE:
90274
CAPACITY: CENSUS: DATE:
09/06/2023
Required - 2 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:EDWARD DEVITTTIME COMPLETED:
01:00 PM
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Home Care Services Bureau (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of CareNet LA on 9/6/2023 at approximately 10:00am. Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Edward Devitt. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. AGPA Vigil was 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 Licensee and no discrepancies were found.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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