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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700364
Report Date: 03/21/2024
Date Signed: 03/21/2024 11:12:31 AM

Document Has Been Signed on 03/21/2024 11:12 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:ATTENTIVE HOME CARE, INCFACILITY NUMBER:
304700364
ADMINISTRATOR:NGO, KIMFACILITY TYPE:
300
ADDRESS:2020 N BROADWAY STE 300TELEPHONE:
(714) 516-9200
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY: CENSUS: DATE:
03/21/2024
Annual/RandomUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Kim Ngo TIME COMPLETED:
11:30 AM
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Home Care Services Bureau (HCSB) analysts Ruben Perez and Mila Quinto arrived at the business office of Attentive Home Care, Inc on March 21, 2024 for an initial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by the administrator, Kim Ngo. 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 the designee, Kim Ngo and informed the designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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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