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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 434700149
Report Date: 07/26/2023
Date Signed: 07/26/2023 01:25:09 PM

Document Has Been Signed on 07/26/2023 01:25 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:FIRSTLIGHT HOME CARE OF SILICON VALLEYFACILITY NUMBER:
434700149
ADMINISTRATOR:LANDAU, JASON NFACILITY TYPE:
300
ADDRESS:1066 SARATOGA AVE SUITE 210TELEPHONE:
(650) 460-3817
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: CENSUS: DATE:
07/26/2023
Annual/RandomUNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:Molly JohnsonTIME COMPLETED:
12:23 PM
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Home Care Services Bureau (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of FirstLight Home Care on 7/26/2023. Upon arrival, AGPA Vigil identified herself and was greeted by Designee, Molly Johnson (General Manager). 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 Designee and informed the Designee that no discrepancies were found.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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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