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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 414700091
Report Date: 04/30/2024
Date Signed: 04/30/2024 09:47:28 AM

Document Has Been Signed on 04/30/2024 09:47 AM - 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:TRUEMED CARE INC.FACILITY NUMBER:
414700091
ADMINISTRATOR/
DIRECTOR:		KOZAKOV, PETERFACILITY TYPE:
300
ADDRESS:400 OYSTER POINT BLVD #201TELEPHONE:
(650) 414-4147
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: CENSUS: DATE:
04/30/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Peter KozakovTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Truemed Care Inc on 4/30/2024 for an initial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Peter Kozakov. 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 Peter and informed the licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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