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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700064
Report Date: 07/11/2023
Date Signed: 07/11/2023 01:12:08 PM

Document Has Been Signed on 07/11/2023 01:12 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:SYNERGY HOMECARE COASTAL CITIESFACILITY NUMBER:
304700064
ADMINISTRATOR:TERESA CHADSEYFACILITY TYPE:
300
ADDRESS:1181 PUERTA DEL SOL, STE 120TELEPHONE:
(949) 310-5420
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92673
CAPACITY: CENSUS: DATE:
07/11/2023
Required - 2 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Caludia BurtonTIME COMPLETED:
01:30 PM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Synergy Homecare Coastal Cities on 7/11/2023 for a biennial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Claudia Burton. 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 Claudia and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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