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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700726
Report Date: 10/01/2025
Date Signed: 10/01/2025 02:49:03 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/01/2025 02:49 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:AROSA - SAN GABRIEL VALLEYFACILITY NUMBER:
194700726
ADMINISTRATOR/
DIRECTOR:		CYRIL VERGISFACILITY TYPE:
300
ADDRESS:65 N. MADISON AVE, STE 106TELEPHONE:
(323) 932-1300
CITY:PASADENASTATE: CAZIP CODE:
91101
CAPACITY: CENSUS: DATE:
10/01/2025
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Ebony Barrientos - Care Specialist & RecruiterTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Arosa San Gabriel Valley on 10/1/25 for a biennial inspection, EA met with Care Specialist & Recruiter Ebony Barrientos. The proper posting of business hours and license was observed. The proof of insurance records were reviewed. 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 Ms. Barrientos and informed her that no discrepancies were found.

EA Chan concluded the visit with an exit interview and provided a copy of this report to Ms. Barrientos.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2025
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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