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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 344700061
Report Date: 01/25/2024
Date Signed: 01/25/2024 04:01:45 PM

Document Has Been Signed on 01/25/2024 04:01 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:PNV SENIOR CARE LLC DBA AMADA SENIOR CAREFACILITY NUMBER:
344700061
ADMINISTRATOR:CALDEIRA, JANIEFACILITY TYPE:
300
ADDRESS:13405 FOLSOM BLVD STE 700TELEPHONE:
(916) 801-4676
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: CENSUS: DATE:
01/25/2024
Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Naveen Vaid & Anjuli DeweesTIME COMPLETED:
03:30 PM
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti, arrived at the business office of Amada Senior Care for a biennial inspection on 1/25/24. Upon arrival, the HCSB analyst identified himself and was greeted by Naveen Vaid and Anjuli Dewees. 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 Naveen and Anjuli and informed them that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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