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Department of
SOCIAL SERVICES
Community Care Licensing
HOME CARE ORGANIZATION EVALUATION REPORT
Facility Number:
484700028
Report Date:
08/31/2023
Date Signed:
09/11/2023 02:11:41 PM
Document Has Been Signed on
09/11/2023 02:11 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 COMPANION PLUS LLC
FACILITY NUMBER:
484700028
ADMINISTRATOR:
NORTHINGTON, MARIA
FACILITY TYPE:
300
ADDRESS:
1013 BROOKSIDE LANE
TELEPHONE:
(925) 789-0248
CITY:
RIO VISTA
STATE:
CA
ZIP CODE:
94571
CAPACITY:
CENSUS:
DATE:
08/31/2023
Required - 2 Year
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
TIME COMPLETED:
11:30 AM
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LICENSING EVALUATOR NAME
:
Megan Vigil
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/31/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/31/2023
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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