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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700892
Report Date: 07/23/2024
Date Signed: 07/23/2024 12:07:46 PM

Document Has Been Signed on 07/23/2024 12:07 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:VISITING ANGELSFACILITY NUMBER:
194700892
ADMINISTRATOR/
DIRECTOR:		NELSON, LEROYFACILITY TYPE:
300
ADDRESS:1147 ROBERTSON BLVD STE 203TELEPHONE:
(323) 512-4357
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY: CENSUS: DATE:
07/23/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Lea ValenciaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Home Care Services Bureau (HCSB) Associate Governmental Program Analyst (AGPA) Joshua Rarela arrived at the business office listed above for a Post Licensing inspection. Upon arrival, the AGPA identified himself and was greeted by the Home Care Organization (HCO) representative named above. The proper posting of business hours and license was observed. The AGPA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review, the AGPA discussed the findings of the inspection with the HCO representative and informed them that there were no discrepancies were found. AGPA provided the HCO representative with this report along with HCS859 - Review of Staff Records.
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE: DATE: 07/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2024
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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