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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700055
Report Date: 06/06/2024
Date Signed: 06/06/2024 03:24:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/06/2024 03:24 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:ASSERTIVE CARE AT HOME, INC.FACILITY NUMBER:
374700055
ADMINISTRATOR/
DIRECTOR:		JOANNALYNE MATROFACILITY TYPE:
300
ADDRESS:8893 LA MESA BLVD, STE FTELEPHONE:
(619) 466-6890
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: CENSUS: DATE:
06/06/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Craig MayTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Home Care Services Bureau (HCSB) Analyst Adrian Mangina arrived at the business office of Assertive Care at Home Inc on 6/6/2024 for a Biennial inspection. Upon arrival, the HCSB analyst identified herself and was greeted by Office Manager Liana Falcon. The proper posting of business hours and license were observed. The analyst was shown to an area where the review of personnel and administrative files could be performed. Analyst observed current insurance policies and dishonesty bond. Upon completion of the file review the analyst discussed the findings of the inspection with the Licensee Craig May and informed Mr. May no discrepancies were found.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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