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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701000
Report Date: 06/19/2024
Date Signed: 06/19/2024 01:35:56 PM

Document Has Been Signed on 06/19/2024 01:35 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:VIP HOME CARE SERVICESFACILITY NUMBER:
194701000
ADMINISTRATOR/
DIRECTOR:		VARDGES MIRZAKHANYANFACILITY TYPE:
300
ADDRESS:100 N BRAND BLVD. #300TELEPHONE:
(747) 777-4346
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY: CENSUS: DATE:
06/19/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Sky MendezTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Home Care Services Bureau (HCSB) Analyst Ryan Chan arrived at the business office of VIP HOME CARE SERVICES on 6/19/24 for a post licensing inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Sky Mendez. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with Sky Mendez and informed her that no discrepancies were found.

Analyst Chan concluded the visit with an exit interview and provided a copy of this report to Sky Mendez.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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