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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700900
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:50:27 PM

Document Has Been Signed on 03/19/2025 01:50 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:VERLIS CARE PROVIDER LLCFACILITY NUMBER:
194700900
ADMINISTRATOR/
DIRECTOR:		TANGUILAN, OLIVERFACILITY TYPE:
300
ADDRESS:13911 AMAR RD STE HTELEPHONE:
(657) 204-1998
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY: CENSUS: DATE:
03/19/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Oliver Tanguilan - Licensee; Mona Lisa Gonzales - LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Verlis Care Provider LLC on 3/19/25 for a post licensing inspection. Upon arrival, EA was greeted by licensees Oliver Tanguilan and Mona Lisa Gonzales. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. EA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EA discussed the findings of the inspection with both licensees and informed them that no discrepancies were found. EA provided licensees with fast facts and forms they can use to help them with their HCO.

EA Chan concluded the visit with an exit interview and provided a copy of this report to the licensees.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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