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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 364700120
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:30:42 PM

Document Has Been Signed on 09/24/2024 01:30 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:FAMILY FIRST VENTURES, INC DBA HOME INSTEADFACILITY NUMBER:
364700120
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, VALARIEFACILITY TYPE:
300
ADDRESS:461 TENNESEE ST STE OTELEPHONE:
(626) 825-7750
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY: CENSUS: DATE:
09/24/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Manny Hernandez III - Franchise OwnerTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Family First Ventures Inc DBA Home Instead on 9/24/24 for a post licensing inspection. Upon arrival, EA met with Franchise Owner Manny Hernandez III. The proper posting of business hours and license was observed and proof of insurance record was reviewed. Owner stated they took over the franchise and the home care aides that were with the prior owner were carried over. EA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EA discussed the findings of the inspection with owner and informed him that no discrepancies were found.

EA concluded the visit with an exit interview and provided a copy of this report along with appeal rights to Manny Hernandez III.

LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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