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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700960
Report Date: 01/10/2025
Date Signed: 01/10/2025 01:54:00 PM

Document Has Been Signed on 01/10/2025 01:54 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:BLEHEALTH LLCFACILITY NUMBER:
194700960
ADMINISTRATOR/
DIRECTOR:		KEULEYA RUTH BLEFACILITY TYPE:
300
ADDRESS:300 S. PARK AVE, STE 850TELEPHONE:
(909) 417-4174
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY: CENSUS: DATE:
01/10/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:KEULEYA RUTH BLE - LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of BLEHEALTH LLC on 1/10/25 for a post licensing inspection. Upon arrival, EA was greeted by licensee Keuleya Ruth Ble. 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. Licensee stated she currently does not have any home care aides (HCA) because they are only doing case management at this time. EA provided guidance to licensee to prepare her for when she starts to hire HCAs as well as provided forms to help licensee keep track of HCA requirements. EA also provided the Department of Social Services Fact Sheet which documents what kind of services an HCA can provide. EA informed licensee that no discrepancies were found at the time of the post licensing inspection.

EA Chan concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the licensee.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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