<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 394700053
Report Date: 10/27/2025
Date Signed: 10/27/2025 01:13:06 PM

Document Has Been Signed on 10/27/2025 01:13 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:THEROLUCK, LLCFACILITY NUMBER:
394700053
ADMINISTRATOR/
DIRECTOR:		LUCKLYN S KPANDEYENGEFACILITY TYPE:
300
ADDRESS:1556 ARRIGOTTI LN.TELEPHONE:
(469) 957-9352
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: CENSUS: DATE:
10/27/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of Theroluck for an initial inspection on 10/27/2025. Upon arrival, the HCSB analyst identified himself and was greeted by Lucklyn Kpandeyenge. 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 the licensee and informed Lucklyn that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Ruben Perez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 1