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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 434700223
Report Date: 06/13/2025
Date Signed: 06/18/2025 08:18:16 AM

Document Has Been Signed on 06/18/2025 08:18 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:LAKSHMI HOME CARE LLCFACILITY NUMBER:
434700223
ADMINISTRATOR/
DIRECTOR:		SHERILL DOMINGOFACILITY TYPE:
300
ADDRESS:1669 FLANIGAN DR UNIT HTELEPHONE:
(669) 242-6928
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: CENSUS: DATE:
06/13/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Wilma AblazaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti, arrived at the business office of Laksmhi Home Care LLC for an initial inspection on 6/13/25. Upon arrival, the HCSB analyst identified himself and was greeted by Wilma Ablaza. 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 Wilma that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Ramsey Chimienti
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2025
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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