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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700810
Report Date: 07/19/2022
Date Signed: 07/19/2022 11:56:58 AM

Document Has Been Signed on 07/19/2022 11:56 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:VICTORY HOME CARE LLCFACILITY NUMBER:
194700810
ADMINISTRATOR:HARRELL, DARIENFACILITY TYPE:
300
ADDRESS:864 GLENWAY DR #5TELEPHONE:
(310) 948-5274
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY: CENSUS: DATE:
07/19/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Darien HarrellTIME COMPLETED:
12:15 PM
NARRATIVE
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Victory Home Care LLC on 7/19/2022. Upon arrival, the HCSB analyst identified himself and was greeted by Darien Harrell. 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 Darien and informed the licensee that no discrepancies were found. In addition, the licensee was provided a printed copy of the LIC 9058 (Applicant/Licensee Rights) form.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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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