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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701007
Report Date: 06/03/2024
Date Signed: 06/03/2024 12:49:42 PM

Document Has Been Signed on 06/03/2024 12:49 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:SYNERGY HOMECARE OF SANTA MONICAFACILITY NUMBER:
194701007
ADMINISTRATOR/
DIRECTOR:		BRANDI WILLIAMSFACILITY TYPE:
300
ADDRESS:1541 OCEAN AVE. #200TELEPHONE:
(310) 576-0456
CITY:SANTA MONICASTATE: CAZIP CODE:
90401
CAPACITY: CENSUS: DATE:
06/03/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Joseph WilliamsTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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Home Care Services Bureau (HCSB) Analyst Ryan Chan arrived at the business office of Synergy Homecare of Santa Monica on 6/3/24 for a post licensing inspection. Upon arrival, Analyst Chan was greeted by Joseph Williams. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. 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 Joseph Williams and informed him that no discrepancies were found.

Analyst 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: 06/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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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