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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 414700132
Report Date: 06/05/2026
Date Signed: 06/05/2026 09:11:03 AM

Document Has Been Signed on 06/05/2026 09:11 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:ASSISTING HANDS SAN CARLOSFACILITY NUMBER:
414700132
ADMINISTRATOR/
DIRECTOR:		MARIA SUFACILITY TYPE:
300
ADDRESS:877 MAHLER ROAD STE 155TELEPHONE:
(650) 227-3792
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: CENSUS: DATE:
06/05/2026
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:01 AM
MET WITH:Tri TranTIME VISIT/
INSPECTION COMPLETED:
09:10 AM
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Enforcement Analyst (EA) Ruben Perez conducted a virtual visit and met with the designee Tri Tran. During the visit, EA verified the posting of the license, observed the operation of the business, confirmed compliance with insurance requirements, reviewed payroll documentation 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: 06/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2026
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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