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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 414700045
Report Date: 12/19/2024
Date Signed: 12/19/2024 12:33:32 PM

Document Has Been Signed on 12/19/2024 12:33 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:AT HOME SUPPORT SENIOR CARE, LLCFACILITY NUMBER:
414700045
ADMINISTRATOR/
DIRECTOR:		J JUSTIN TUVILLAFACILITY TYPE:
300
ADDRESS:1590 EL CAMINO REAL STE KTELEPHONE:
(650) 585-4447
CITY:SAN BRUNOSTATE: CAZIP CODE:
94066
CAPACITY: CENSUS: DATE:
12/19/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Josielyn MallorcaTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of At Home Support Senior Care LLC for a biennial inspection on 12/19/2024. Upon arrival, the HCSB analyst identified himself and was greeted by Josielyn Mallorca. 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 designee and informed Josielyn that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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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