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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 314700024
Report Date: 01/05/2024
Date Signed: 01/10/2024 11:13:52 AM

Document Has Been Signed on 01/10/2024 11:13 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:OPTIMISTPRIMECARE LLCFACILITY NUMBER:
314700024
ADMINISTRATOR:BUENA, JANETFACILITY TYPE:
300
ADDRESS:939 OLD RANCH HOUSE RDTELEPHONE:
(916) 895-1199
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: CENSUS: DATE:
01/05/2024
Required - 2 YearUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Janet BuenaTIME COMPLETED:
04:20 PM
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Home Care Services Branch (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil, arrived at the business office of Optimist Prime Care LLC for a Two Year Required Inspection on 1.5.2023 at approximately 3:30 PM.

Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Janet Buena. 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, AGPA Vigil discussed the findings of the inspection with the Licensee. Advised there were not any deficiencies found to report.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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