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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 434700008
Report Date: 01/18/2024
Date Signed: 01/18/2024 12:25:08 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/18/2024 12:25 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:HOME HELPERS OF SANTA CLARA VALLEYFACILITY NUMBER:
434700008
ADMINISTRATOR:KETAN SHAHFACILITY TYPE:
300
ADDRESS:1155 MERIDIAN AVE, STE. 110TELEPHONE:
(408) 259-5930
CITY:SAN JOSESTATE: CAZIP CODE:
94125
CAPACITY: CENSUS: DATE:
01/18/2024
Required - 2 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ketan Shah / Ranjitha RajacharTIME COMPLETED:
12:30 PM
NARRATIVE
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti, arrived at the business office of Home Helpers of Santa Clara Valley for a biennial inspection on 1/18/24. Upon arrival, the HCSB analyst identified himself and was greeted by Ranjitha Rajachar and Ketan Shah. 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 Ranjitha and Ketan and informed the Designee and Licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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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