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

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 494700005
Report Date: 06/12/2024
Date Signed: 06/12/2024 10:37:23 AM

Document Has Been Signed on 06/12/2024 10:37 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:ACCENTCARE OF CA - PETALUMAFACILITY NUMBER:
494700005
ADMINISTRATOR/
DIRECTOR:		KOTCH, KAYLAFACILITY TYPE:
300
ADDRESS:1301 REDWOOD WAY, SUITE 105TELEPHONE:
(707) 792-2211
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: CENSUS: DATE:
06/12/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Licensee - Kayla KotchTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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 Branch (HCSB) Analysts, Todd Borcher and Wendy Scott, arrived at the business office of Accentcare of CA - Petaluma for a Two-Year Licensing inspection on June 12, 2024. Upon arrival, the Analysts identified themselves and were greeted by Licensee Kayla Kotch. The proper posting of business hours and license was observed. The Analysts were then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the Analysts discussed the findings of the inspection with the Licensee and informed the Licensee that no discrepancies were found. A copy of the report was provided with appeal rights. Exit interview was conducted.
LICENSING EVALUATOR NAME: Todd Borcher
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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