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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700542
Report Date: 11/14/2024
Date Signed: 11/14/2024 02:16:47 PM

Document Has Been Signed on 11/14/2024 02:16 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:PREMIER SENIOR CAREFACILITY NUMBER:
194700542
ADMINISTRATOR/
DIRECTOR:		WILLIAM ERICKSONFACILITY TYPE:
300
ADDRESS:100 WEST BROADWAY SUITE 3000TELEPHONE:
(310) 871-7194
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY: CENSUS: DATE:
11/14/2024
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Marcie Barrett - DesigneeTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Premier Senior Care on 11/14/24 for a biennial inspection. Upon arrival, EA identified himself and was greeted by designee Marcie Barrett. The proper posting of business hours and license was observed. 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 the designee and informed her that no discrepancies were found.

EA concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the designee.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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