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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701061
Report Date: 10/01/2025
Date Signed: 10/01/2025 06:09:17 PM

Document Has Been Signed on 10/01/2025 06:09 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:UNIQUE SUPPORT HOME CARE AGENCY, THEFACILITY NUMBER:
194701061
ADMINISTRATOR/
DIRECTOR:		CAMOCAMO, MYLENFACILITY TYPE:
300
ADDRESS:272 S REXFORD DR APT 206TELEPHONE:
(310) 497-1288
CITY:BEVERLY HILLSSTATE: CAZIP CODE:
90212
CAPACITY: CENSUS: DATE:
10/01/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Mylen CamocamoTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On October 1 2025, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Unique Support Home Care Agency for a post Licensing inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Mylen Camocamo. Analyst was provided with an area in which the review of personnel and administrative files could be performed. Analyst Mangina observed the proper posting of License and business hours. Designee will provide Analyst with proof of valid professional liability policy, worker's compensation, and dishonesty bond by email.

Upon completion of the file review Analyst discussed the findings of the inspection with Ms. Camocamo and informed Designee that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Adrian L Mangina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2025
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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