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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700407
Report Date: 03/18/2024
Date Signed: 03/18/2024 10:20:45 AM

Document Has Been Signed on 03/18/2024 10:20 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:GRACEFUL DAY PERSONAL HOME CARE, LLCFACILITY NUMBER:
304700407
ADMINISTRATOR:ROSELINE BRANDA ANDREFACILITY TYPE:
300
ADDRESS:824 S FALCON ST. #CTELEPHONE:
(954) 494-3146
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: CENSUS: DATE:
03/18/2024
Post LicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Roseline AndreTIME COMPLETED:
10:30 AM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Graceful Day Personal Home Care on 3/18/2024 for an initial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Roseline Andre. 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 Roseline and informed the licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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