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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700278
Report Date: 09/27/2023
Date Signed: 09/27/2023 04:28:26 PM

Document Has Been Signed on 09/27/2023 04:28 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:AMADA SENIOR CAREFACILITY NUMBER:
304700278
ADMINISTRATOR:JEFFERSON, TAFAFACILITY TYPE:
300
ADDRESS:24361 EL TORO RD STE 205TELEPHONE:
(949) 528-3500
CITY:LAGUNA WOODSSTATE: CAZIP CODE:
92637
CAPACITY: CENSUS: DATE:
09/27/2023
Required - 2 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tafa JeffersonTIME COMPLETED:
04:30 PM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Amada Senior Care on 9/27/2023 for a biennial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Tafa Jefferson. 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 Tafa and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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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