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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 414700131
Report Date: 05/14/2026
Date Signed: 05/14/2026 11:44:27 AM

Document Has Been Signed on 05/14/2026 11:44 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
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:TENDER ROSE DEMENTIA CARE SPECIALISTSFACILITY NUMBER:
414700131
ADMINISTRATOR/
DIRECTOR:		THOMAS, JESSICAFACILITY TYPE:
300
ADDRESS:2001 JUNIPER SERRA BLVD #520TELEPHONE:
(415) 340-3990
CITY:DALY CITYSTATE: CAZIP CODE:
94014
CAPACITY: CENSUS: DATE:
05/14/2026
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Michael BallesterosTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Enforcement Analyst (EA) Ruben Perez conducted a virtual visit and met with the licensee Michael Ballesteros. During the visit, EA verified the posting of the license, observed the operation of the business, confirmed compliance with insurance requirements, and completed the required personnel file review. All requested documentation was provided and reviewed.

The Home Care Organization (HCO) was found to be in compliance with applicable Health and Safety Code requirements. No deficiencies were cited. An exit interview was conducted, and copies of 809 Facility Evaluation, 859 Staff Records Review Report, and appeal rights information were provided via email.

NAME OF LICENSING PROGRAM ANALYST: Ruben Perez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2026
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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