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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 344700080
Report Date: 12/21/2021
Date Signed: 12/21/2021 10:30:43 AM

Document Has Been Signed on 12/21/2021 10:30 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:ALICE CAREFACILITY NUMBER:
344700080
ADMINISTRATOR:TOMMASO ESMANECHFACILITY TYPE:
300
ADDRESS:8146 GREENBACK LN #106TELEPHONE:
(916) 494-1021
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 0CENSUS: DATE:
12/21/2021
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Trina KaplowTIME COMPLETED:
11:00 AM
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Home Care Services Bureau (HCSB) Analyst, Ramsey Chimienti arrived at the business office of Alice Care on 12/21/21. Upon arrival, the HCSB analyst identified himself and was greeted by Trina Kaplow. 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 Trina and informed her that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
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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