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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700029
Report Date: 01/23/2025
Date Signed: 01/23/2025 09:46:42 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/23/2025 09:46 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:ASSISTANCE IN HOME CAREFACILITY NUMBER:
304700029
ADMINISTRATOR/
DIRECTOR:		RAMONA STREITFACILITY TYPE:
300
ADDRESS:12832 VALLEY VIEW ST SUITE 211TELEPHONE:
(714) 622-5852
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY: CENSUS: DATE:
01/23/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Matthew Streit, DesigneeTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on site inspection for the purpose of a biennial visit. The EA met with designee, Matthew Streit. The EA observed the posting of the license and operating business hours. Business operating hours are from 8am-1pm, Tuesdays and Thursdays.

During the inspection, the EA reviewed personnel records for licensee, staff and Home Care Aides including fingerprint status', registry status', Tuberculosis (TB), and required training. The HCO’s business records were also reviewed during the visit including designee in the absence of the licensee and insurance requirements.

During today’s visit, EA Quinto found the HCO was in compliance and no deficiencies were cited.

An exit interview was conducted, a copy of this report (HCS809), staff records review (HCS 859) and appeal rights were provided to the licensee representative via email.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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