<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 314700032
Report Date: 04/13/2023
Date Signed: 04/13/2023 02:31:06 PM

Document Has Been Signed on 04/13/2023 02:31 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:AMEVIANFACILITY NUMBER:
314700032
ADMINISTRATOR:WHEELER, TIMOTHYFACILITY TYPE:
300
ADDRESS:3897 PEACH DRTELEPHONE:
(855) 263-8426
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY: CENSUS: DATE:
04/13/2023
Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Timothy WheelerTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Home Care Services Bureau (HCSB) analyst Ramsey Chimienti arrived at the business office of Amevian for an initial inspection on 4/13/23. Upon arrival, the HCSB analyst identified himself and was greeted by Timothy Wheeler. 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 Timothy and informed the Licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 1