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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 214700013
Report Date: 06/11/2024
Date Signed: 06/11/2024 10:31:10 AM

Document Has Been Signed on 06/11/2024 10:31 AM - 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:KINDRED AT HOMEFACILITY NUMBER:
214700013
ADMINISTRATOR/
DIRECTOR:		FAYE MITCHELLFACILITY TYPE:
300
ADDRESS:185 N. REDWOOD DRIVE, STE. 150TELEPHONE:
(415) 499-1406
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY: CENSUS: DATE:
06/11/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Licensee - Sharon ChungTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Home Care Services Bureau (HCSB) Analyst, Todd Borcher, arrived at the business office of Kindred at Home for a Two-Year Licensing inspection on June 11, 2024. Upon arrival, the Analyst identified himself and was greeted by Licensee Sharon Chung. The proper posting of business hours and license was observed. 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 the Licensee and informed the Licensee that no discrepancies were found. A copy of the report was provided with appeal rights. Exit interview was conducted.
LICENSING EVALUATOR NAME: Todd Borcher
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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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