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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 314700037
Report Date: 07/25/2023
Date Signed: 07/25/2023 05:21:19 PM

Document Has Been Signed on 07/25/2023 05:21 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:HOME INSTEAD SENIOR CAREFACILITY NUMBER:
314700037
ADMINISTRATOR:SYMPHONY KRUEGERFACILITY TYPE:
300
ADDRESS:173 PALM AVE.TELEPHONE:
(530) 885-3904
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: CENSUS: DATE:
07/25/2023
Annual/RandomUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Symphony KruegerTIME COMPLETED:
04:00 PM
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Home Care Services Bureau (HCSB) analyst Ramsey Chimienti arrived at the business office of Home Instead Senior Care for an Initial inspection on 7/25/23. Upon arrival, the HCSB analyst identified himself and was greeted by Symphony Krueger. 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 Symphony and informed the Licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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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