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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700255
Report Date: 05/02/2022
Date Signed: 05/02/2022 02:45:35 PM

Document Has Been Signed on 05/02/2022 02:45 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:GENKI HOME CAREFACILITY NUMBER:
374700255
ADMINISTRATOR:KANEKO, EUGENEFACILITY TYPE:
300
ADDRESS:1260 THIRD AVETELEPHONE:
(858) 699-7020
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: CENSUS: DATE:
05/02/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Coreen FujinamiTIME COMPLETED:
03:00 PM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Genki Home Care on 5/2/2022. Upon arrival, the HCSB analyst identified himself and was greeted by Coreen Fujinami. 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 Coreen and informed the licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2022
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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