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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 414700134
Report Date: 06/25/2025
Date Signed: 06/25/2025 10:17:42 AM

Document Has Been Signed on 06/25/2025 10:17 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:FAMILY CARE AT HOMEFACILITY NUMBER:
414700134
ADMINISTRATOR/
DIRECTOR:		GIRSH, ALEXFACILITY TYPE:
300
ADDRESS:330 PRIMROSE RD #214TELEPHONE:
(415) 305-5301
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY: CENSUS: DATE:
06/25/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Alex GirshTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of Family Care At Home for an initial inspection on 6/25/2025. Upon arrival, the HCSB analyst identified himself and was greeted by Alex Girsh. 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 Alex that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Ruben Perez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2025
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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