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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 314700018
Report Date: 04/12/2023
Date Signed: 04/12/2023 12:42:24 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/12/2023 12:42 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:FIRSTLIGHT HOME CARE OF PLACER COUNTYFACILITY NUMBER:
314700018
ADMINISTRATOR:PAUL TERPELUKFACILITY TYPE:
300
ADDRESS:735 SUNRISE AVE STE #160TELEPHONE:
(916) 742-5328
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: CENSUS: DATE:
04/12/2023
Required - 2 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Paul TerpelukTIME COMPLETED:
12:45 PM
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Home Care Services Bureau (HCSB) analyst Ramsey Chimienti arrived at the business office of Firstlight Home Care Of Placer County on 4/12/23. Upon arrival, the HCSB analyst identified himself and was greeted by Paul Terpeluk. 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 Paul and informed the Licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
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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