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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 364700052
Report Date: 03/26/2026
Date Signed: 03/26/2026 12:10:57 PM

Document Has Been Signed on 03/26/2026 12:10 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:AFFECTIVE HEALTHCARE, INC.FACILITY NUMBER:
364700052
ADMINISTRATOR/
DIRECTOR:		JUSTIN I. FELIPEFACILITY TYPE:
300
ADDRESS:5050 PALO VERDE ST. STE.206TELEPHONE:
(818) 929-4970
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: CENSUS: DATE:
03/26/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Justin Felipe, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Home Care Services Branch (HCSB), Enforcement Analyst (EA), Jane Cong-Huyen spoke to licensee, Justin Felipe, to conduct a telephone pre-inspection interview. Licensee confirmed HCO Information. The HCO is due for a biennial visit and has agreed to a virtual inspection visit with EA.

The virtual inspection visit is scheduled for Friday 4/3/2026 @ 2:30pm via Microsoft Teams. EA emailed the HCO with specific instructions regarding the virtual licensing inspection and the required documentation for the HCO to submit to EA via email before/by Wednesday COB 4/1/2026.

The HCO will be receiving this report via email. HCO will send report back to EA with signature as soon as possible or by COB today to confirm the virtual inspection visit.

NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2026
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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