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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 414700133
Report Date: 05/29/2025
Date Signed: 05/29/2025 12:29:07 PM

Document Has Been Signed on 05/29/2025 12:29 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:ACTI-KARE RESPONSIVE IN-HOME CAREFACILITY NUMBER:
414700133
ADMINISTRATOR/
DIRECTOR:		ZELAYA, LIZBETFACILITY TYPE:
300
ADDRESS:1799 OLD BAYSHORE HWY STE 288TELEPHONE:
(650) 465-2726
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: CENSUS: DATE:
05/29/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Lizbet ZelayaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of Acti-Kare Responsive In-Home Care for an initial inspection on 5/29/2025. Upon arrival, the HCSB analyst identified himself and was greeted by Lizbet Zelaya. 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 licensee and informed Lizbet that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Ruben Perez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2025
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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