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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 434700019
Report Date: 09/11/2025
Date Signed: 09/26/2025 03:58:27 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/26/2025 03:58 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:FAMILIAR SURROUNDINGS HOME CARE, LLCFACILITY NUMBER:
434700019
ADMINISTRATOR/
DIRECTOR:		PAMELA GREENEFACILITY TYPE:
300
ADDRESS:1568 MERIDIAN AVETELEPHONE:
(408) 979-9990
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: CENSUS: DATE:
09/11/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Pam GreenTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti, arrived at the business office of Familiar Surroundings Home Care for a biennial inspection on 9/11/25. Upon arrival, the HCSB analyst identified himself and was greeted by Pam Green. 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 Pam that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Ramsey Chimienti
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2025
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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