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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 414700106
Report Date: 02/08/2022
Date Signed: 02/08/2022 10:44:28 AM

Document Has Been Signed on 02/08/2022 10:44 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:ULTIMATE HOME CARE SERVICESFACILITY NUMBER:
414700106
ADMINISTRATOR:MARAVOU, SITERIFACILITY TYPE:
300
ADDRESS:2317 GLEN WAYTELEPHONE:
(650) 208-8948
CITY:EAST PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 0CENSUS: DATE:
02/08/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Siteri MaravouTIME COMPLETED:
11:15 AM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Ultimate Home Care Services on 2/8/2022. Upon arrival, the HCSB analyst identified himself and was greeted by Siteri Maravou. 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 Siteri and informed the licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2022
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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