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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701117
Report Date: 05/06/2025
Date Signed: 05/06/2025 03:02:47 PM

Document Has Been Signed on 05/06/2025 03:02 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:AMADA SENIOR CARE CARSON CAFACILITY NUMBER:
194701117
ADMINISTRATOR/
DIRECTOR:		YANAN GUOFACILITY TYPE:
300
ADDRESS:500 E. CARSON PLAZA STE 106TELEPHONE:
(424) 219-2169
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: CENSUS: DATE:
05/06/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Yanan Guo - LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Amada Senior Care Carson CA on 5/6/25 for a post licensing inspection. Upon arrival, EA was greeted by licensee Yanan Guo. 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 the licensee and informed her that no discrepancies were found.

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

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2025
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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