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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701022
Report Date: 01/31/2025
Date Signed: 01/31/2025 02:49:33 PM

Document Has Been Signed on 01/31/2025 02:49 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:BLUE EAGLE SERVICES, INC.FACILITY NUMBER:
194701022
ADMINISTRATOR/
DIRECTOR:		PERFECTO GALLARDOFACILITY TYPE:
300
ADDRESS:454 S CENTRAL AVE. #BTELEPHONE:
(818) 502-9677
CITY:GLENDALESTATE: CAZIP CODE:
91204
CAPACITY: CENSUS: DATE:
01/31/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Perfecto Gallardo, Licensee and Ezekiel Sia, Administrative AssistantTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Blue Eagle Services, Inc on 1/31/25 for a post licensing inspection. Upon arrival, EA was greeted by licensee Perfecto Gallardo and Administrative Assistant Ezekiel Sia. The proper posting of business hours and license was observed. EA was then shown to an area where the review of personnel and administrative files could be performed. The proof of insurance's record was reviewed. Licensee stated he currently does not have any home care aides (HCA), therefore, EA did not have HCA files to review. EA went over the training requirements, tuberculosis testing requirements, HCA registry requirements and provided the training log and personnel folder checklist to licensee.

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

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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