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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 314700025
Report Date: 12/20/2021
Date Signed: 12/20/2021 04:19:37 PM

Document Has Been Signed on 12/20/2021 04:19 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:AMOR CARE, INC.FACILITY NUMBER:
314700025
ADMINISTRATOR:HIDALGO, GABRIEL THOREAUFACILITY TYPE:
300
ADDRESS:3250 BLUE OAKS DR, STE 350TELEPHONE:
(916) 622-1653
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY: 0CENSUS: DATE:
12/20/2021
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Theresa HaleenTIME COMPLETED:
04:30 PM
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Home Care Services Bureau (HCSB) Analyst, Ramsey Chimienti arrived at the business office of Amor Care, Inc. on 12/20/21. Upon arrival, the HCSB analyst identified himself and was greeted by Theresa Haleen. 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 Theresa and informed her that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2021
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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