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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700754
Report Date: 03/24/2022
Date Signed: 04/04/2022 08:57:27 AM

Document Has Been Signed on 04/04/2022 08:57 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:SKILLED HOME CARE SOLUTIONSFACILITY NUMBER:
194700754
ADMINISTRATOR:PHIL REIDFACILITY TYPE:
300
ADDRESS:30101 AGOURA CT STE 205TELEPHONE:
(800) 707-1194
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY: CENSUS: DATE:
03/24/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:TIME COMPLETED:
04:00 PM
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On 3/24/2022, an attempt was made to perform an unannounced inspection of Skilled Home Care Solutions. A licensee or designee shall be continuously present during the Home Care Organization’s (HCO) business office hours. Any additional incomplete inspections may result in the issuance of civil penalties or possible license revocation. Please notify your assigned analyst of any changes to the HCO location or anticipated hours of operation.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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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