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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700815
Report Date: 07/18/2022
Date Signed: 08/01/2022 09:48:08 AM

Document Has Been Signed on 08/01/2022 09:48 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
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:24HR HOMECARE L.L.C.FACILITY NUMBER:
194700815
ADMINISTRATOR:HWANG, LINFACILITY TYPE:
300
ADDRESS:5901 GREEN VALLEY CIR STE470TELEPHONE:
(310) 258-9525
CITY:CULVER CITYSTATE: CAZIP CODE:
90245
CAPACITY: CENSUS: DATE:
07/18/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:TIME COMPLETED:
01:15 PM
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On 7/18/2022, an attempt was made to perform an unannounced inspection of 24hr Homecare LLC. 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: 07/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2022
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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