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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 214700041
Report Date: 02/19/2025
Date Signed: 02/19/2025 10:42:45 AM

Document Has Been Signed on 02/19/2025 10:42 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:TENDER ROSE DEMENTIA CARE SPECIALISTSFACILITY NUMBER:
214700041
ADMINISTRATOR/
DIRECTOR:		REYES, MELISSAFACILITY TYPE:
300
ADDRESS:1000 4TH STREET STE 150TELEPHONE:
(415) 340-3990
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: CENSUS: DATE:
02/19/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Designee - Mike BallesterosTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Home Care Services Branch (HCSB) Analyst, Todd Borcher, arrived at the business office of Tender Rose Dementia Care Specialists for a Two-Year Licensing inspection on February 19, 2025. Upon arrival, the Analyst identified himself and was greeted by designee Mike Ballesteros. 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 designee and informed the designee 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: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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