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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700770
Report Date: 03/02/2023
Date Signed: 03/02/2023 01:20:17 PM

Document Has Been Signed on 03/02/2023 01:20 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:ABSOLUTE CARE HOME AGENCY LLCFACILITY NUMBER:
194700770
ADMINISTRATOR:SUSA, ELIZALDE T.FACILITY TYPE:
300
ADDRESS:1010 E ACACIA AVE 113TELEPHONE:
(661) 436-4666
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: CENSUS: DATE:
03/02/2023
Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Geraldine SusaTIME COMPLETED:
02:00 PM
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Home Care Services Bureau (HCSB) analysts Ruben Perez and Megan Vigil arrived at the business office of Absolute Care Home Agency on 3/2/2023 for an initial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Geraldine Susa. 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 Geraldine and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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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