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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700588
Report Date: 04/18/2024
Date Signed: 04/18/2024 10:01:55 AM

Document Has Been Signed on 04/18/2024 10:01 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:FIRST LIGHT HOME CARE PASADENAFACILITY NUMBER:
194700588
ADMINISTRATOR/
DIRECTOR:		DAVID KAPOJOSFACILITY TYPE:
300
ADDRESS:612 W. DUARTE ROAD, SUITE 404TELEPHONE:
(626) 710-2022
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: CENSUS: DATE:
04/18/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Gabriela MorenoTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of First Light Home Care Pasadena on 4/18/2024 for a biennial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Gabriela Moreno. 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 Gabriela and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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