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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700998
Report Date: 10/18/2024
Date Signed: 10/18/2024 01:31:29 PM

Document Has Been Signed on 10/18/2024 01:31 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:1HEART CAREGIVER SERVICESFACILITY NUMBER:
194700998
ADMINISTRATOR/
DIRECTOR:		EVAN GARCIAFACILITY TYPE:
300
ADDRESS:3605 LONG BEACH BLVD STE 233-DTELEPHONE:
(909) 681-4656
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: CENSUS: DATE:
10/18/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Robb Tan - LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of 1Heart Caregiver Services on 10/18/24 for a post licensing inspection. Upon arrival, EA was greeted by Licensee, Robb Tan 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 Licensee and informed the Licensee that no discrepancies were found.

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

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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