<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 484700034
Report Date: 08/31/2023
Date Signed: 09/11/2023 09:18:32 AM

Document Has Been Signed on 09/11/2023 09:18 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:INTERIM HEALTHCARE OF VACAVILLEFACILITY NUMBER:
484700034
ADMINISTRATOR:WASIF HUSSAINFACILITY TYPE:
300
ADDRESS:1652 W TEXAS ST. #227TELEPHONE:
(707) 623-1130
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: CENSUS: DATE:
08/31/2023
Post LicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Wasif HussainTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Home Care Services Bureau (HCSB) Associate Government Program Analyst (AGPA) Megan Vigil arrived at the business office of Interim Healthcare of Vacaville on 8/31/2023 at approximately 12:00pm. Upon arrival, AGPA Vigil identified herself and was greeted by Licensee, Wasif Hussain. The proper posting of business hours and license was observed. The proof of insurance's record was reviewed. 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 Licensee and informed the Licensee that no discrepancies were found.
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)
Page: 1 of 1