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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 364700007
Report Date: 02/26/2025
Date Signed: 02/26/2025 03:03:12 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/26/2025 03:03 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:SENIOR HOME CAREGIVERS, INC.FACILITY NUMBER:
364700007
ADMINISTRATOR/
DIRECTOR:		DAVIS, BRIANFACILITY TYPE:
300
ADDRESS:1003 E. COOLEY DR., SUITE 203TELEPHONE:
(909) 867-7787
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: CENSUS: DATE:
02/26/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Brian Davis, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Enforcement Analysts (EAs), Jane Cong-Huyen and Mila Quinto, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of 2 year required visit. The EAs met with licensee, Brian Davis. The EAs observed the posting of the license and operating business hours. Business operating hours are, Monday thru Thursday 8:00am - 5:00pm and Friday: 8:00am - 2:00pm.

During the inspection, the EAs reviewed personnel records for licensee, staff and Home Care Aides including fingerprint status, registry status, Tuberculosis (TB), and required training. The HCO’s business records including document for designee in the absence of the licensee and insurance requirements were also reviewed during the visit.

EAs Cong-Huyen and Quinto found the HCO in compliance and no deficiencies were cited. An exit interview was conducted, a copy of this report (HCS809), was provided to the licensee, Brian Davis, via email.
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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