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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700636
Report Date: 10/18/2024
Date Signed: 10/18/2024 03:57:00 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/18/2024 03:57 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:SILVER PEAKS LLCFACILITY NUMBER:
194700636
ADMINISTRATOR/
DIRECTOR:		EMMA CATIPON ROGONGFACILITY TYPE:
300
ADDRESS:3780 KILROY AIRPORT WAY, #200TELEPHONE:
(424) 558-7219
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: CENSUS: DATE:
10/18/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Abdul Rahman Esmail - DesigneeTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Silver Peaks LLC on 10/18/24 for a biennial inspection. Upon arrival, EA identified himself and was greeted by designee Abdul Rahman Esmail. 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 the designee and informed him 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.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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