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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 434700188
Report Date: 09/21/2023
Date Signed: 09/26/2023 03:35:31 PM

Document Has Been Signed on 09/26/2023 03:35 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:COMFORCARE HOME CARE CENTRAL SAN JOSEFACILITY NUMBER:
434700188
ADMINISTRATOR:CLIFFORD SHAWFACILITY TYPE:
300
ADDRESS:6455 ALMANDEN EXPRESSWAY #103TELEPHONE:
(408) 666-0574
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY: CENSUS: DATE:
09/21/2023
Post LicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Clifford ShawTIME COMPLETED:
10:30 AM
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Home Care Services Bureau (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of Comforcare Home Care Central San Jose on 9.21.2023 at approximately 9:00am. Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Clifford Shaw. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. AGPA Vigil was 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 Licensee and no discrepancies were found.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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