<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700721
Report Date: 09/10/2024
Date Signed: 09/10/2024 12:35:41 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/10/2024 12:35 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:CARE TO STAY HOMEFACILITY NUMBER:
194700721
ADMINISTRATOR/
DIRECTOR:		KOONTZ, BRIANFACILITY TYPE:
300
ADDRESS:611 N BRAND BLVD, STE 1300TELEPHONE:
(818) 446-6966
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY: CENSUS: DATE:
09/10/2024
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Brian Koontz - Managing PartnerTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Care to Stay Home on 9/10/24 for a biennial inspection. Upon arrival, EA identified himself and was greeted by Brian Koontz, Managing Partner. 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 the analyst discussed the findings of the inspection with Brian Koontz 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 to Brian Koontz.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 1