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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700582
Report Date: 11/06/2024
Date Signed: 11/06/2024 11:05:37 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/06/2024 11:05 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
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:EMERALD CAREGIVING AGENCYFACILITY NUMBER:
194700582
ADMINISTRATOR/
DIRECTOR:		MICHAEL NOCOSFACILITY TYPE:
300
ADDRESS:265 E CARSON STTELEPHONE:
(424) 287-2096
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: CENSUS: DATE:
11/06/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Theresa Pineda - ClerkTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Emerald Caregiving Agency on 11/6/24 for a biennial inspection. Upon arrival, EA identified himself and was greeted by front desk clerk Theresa Pineda. 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 Theresa Pineda and informed her that no discrepancies were found.

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

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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