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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700567
Report Date: 08/30/2023
Date Signed: 08/30/2023 03:19:36 PM

Document Has Been Signed on 08/30/2023 03:19 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:HOME INSTEAD SENIOR CAREFACILITY NUMBER:
194700567
ADMINISTRATOR:RICHARD SOUTHARDFACILITY TYPE:
300
ADDRESS:13585 WHITTIER BLVD STE 104TELEPHONE:
(562) 698-8600
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: CENSUS: DATE:
08/30/2023
Post LicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:DaShee MillerTIME COMPLETED:
02:15 PM
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Home Care Services Bureau (HCSB) analyst Ramsey Chimienti arrived at the business office of Home Instead Senior Care for biennial inspection on 8/30/2023. Upon arrival, the HCSB analyst identified himself and was greeted by DaShee Miller. 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 Dashee and informed the Designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2023
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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