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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701016
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:28:17 PM

Document Has Been Signed on 09/19/2024 02:28 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:DAISY'S ANGEL CAREFACILITY NUMBER:
194701016
ADMINISTRATOR/
DIRECTOR:		JAYNES ABARRIENTOSFACILITY TYPE:
300
ADDRESS:5415 PARMERTON AVE.TELEPHONE:
(626) 203-8570
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY: CENSUS: DATE:
09/19/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Designee Hannah Chang and Jaynes Juree AbarrientosTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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Home Care Services Branch Enforcement Analyst (EA) Ryan Chan arrived at the business office of Daisy's Angel Care on 9/19/24 for a post licensing inspection. Upon arrival, EA was greeted by designee Hannah Chang, about 15 minutes later designee Jaynes Juree Abarrientos arrived. 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 designee Jaynes Juree Abarrientos and informed him 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 to Jaynes Juree Abarrientos.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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