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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700040
Report Date: 06/28/2024
Date Signed: 06/28/2024 12:33:38 PM

Document Has Been Signed on 06/28/2024 12:33 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:ACCENTCARE OF CA - LAKE FORESTFACILITY NUMBER:
304700040
ADMINISTRATOR/
DIRECTOR:		SCHULTZ, HANNAHFACILITY TYPE:
300
ADDRESS:23725 BIRTCHER DRIVE, STE 150TELEPHONE:
(925) 685-9555
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: CENSUS: DATE:
06/28/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Laura Hernandez, DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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Home Care Services Bureau (HCSB) Analyst, Mila Quinto arrived at the business office for a post licensing inspection. Upon arrival, Analyst Quinto was greeted by Designee, Laura Hernandez. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. 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 that no discrepancies were found.
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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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