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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 404700009
Report Date: 05/19/2026
Date Signed: 05/19/2026 01:58:53 PM

Document Has Been Signed on 05/19/2026 01:58 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 HOME CAREFACILITY NUMBER:
404700009
ADMINISTRATOR/
DIRECTOR:		MARY SCHULTZFACILITY TYPE:
300
ADDRESS:620 WEST TEFFT ST.TELEPHONE:
(805) 458-0002
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: CENSUS: DATE:
05/19/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Johnathan IrishTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Enforcement Analyst (EA) Perez contacted Family Home Care, by telephone on 5/19/26. EA Perez introduced themselves and explained their role with the Home Care Services Branch (HCSB). The purpose of the call was to discuss and schedule the required biennial licensing visit. EA Perez and a representative from the Home Care Organization agreed to conduct the visit virtually on 5/26/26.

The option of conducting the visit virtually was explained in detail, including the technology requirements, participation expectations, and how all applicable licensing requirements would be met remotely. File review expectations were also discussed, including that all records must be complete, legible, accessible, and available before and during the visit. Attendance requirements and overall licensing expectations were reviewed.

The Licensee confirmed their ability to meet the virtual visit requirements and agreed that a virtual visit was appropriate. The date, time, and format of the visit were confirmed, and the Licensee acknowledged understanding of all expectations and requirements.

NAME OF LICENSING PROGRAM ANALYST: Ruben Perez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2026
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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