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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700581
Report Date: 06/30/2026
Date Signed: 06/30/2026 03:30:16 PM

Document Has Been Signed on 06/30/2026 03:30 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:EXTRACAREFACILITY NUMBER:
194700581
ADMINISTRATOR/
DIRECTOR:		BETELHEM SHIFERAWFACILITY TYPE:
300
ADDRESS:9236 GERALD AVETELEPHONE:
(310) 634-3173
CITY:NORTHRIDGESTATE: CAZIP CODE:
91343
CAPACITY: CENSUS: DATE:
06/30/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Betelhem ShiferawTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) spoke with the Home Care Organization (HCO) representative named above regarding a Biennial inspection.

An In-Person Biennial inspection is scheduled for July 7, 2026 at 10AM.
NAME OF LICENSING PROGRAM ANALYST: Joshua Rarela
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2026
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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