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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700560
Report Date: 03/01/2022
Date Signed: 03/15/2022 10:42:46 AM

Document Has Been Signed on 03/15/2022 10:42 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:IN GOOD HANDS HOME CARE LLCFACILITY NUMBER:
194700560
ADMINISTRATOR:ESMERALDA CASTROFACILITY TYPE:
300
ADDRESS:8950 W OLYMPIC BLVD STE 122TELEPHONE:
(310) 435-2148
CITY:BEVERLY HILLSSTATE: CAZIP CODE:
90211
CAPACITY: CENSUS: DATE:
03/01/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:TIME COMPLETED:
02:45 PM
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On 3/1/2022, an attempt was made to perform an unannounced inspection of In Good Hands Home Care LLC. A licensee or designee shall be continuously present during the Home Care Organization’s (HCO) business office hours. Any additional incomplete inspections may result in the issuance of civil penalties or possible license revocation. Please notify your assigned analyst of any changes to the HCO location or anticipated hours of operation.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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