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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 214700041
Report Date: 01/27/2026
Date Signed: 02/04/2026 11:17:50 AM

Document Has Been Signed on 02/04/2026 11:17 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:
01/27/2026
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:59 PM
MET WITH:Mike BallesterosTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Enforcement Analyst (EA) Yolanda Hankerson, meet with the Licensee, to conduct an (biennial)visit. During the visit Mike provided documentation for caregiver files and license requirements. The Home care Organization (HCO) had no deficiencies. Exit interview was conducted with Licensee and was given copy of reports 809, and the Appeal Rights form 508. 
NAME OF LICENSING PROGRAM ANALYST: Yolanda Hankerson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2026
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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