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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 494700063
Report Date: 04/09/2025
Date Signed: 04/09/2025 12:17:05 PM

Document Has Been Signed on 04/09/2025 12:17 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:HILLENDALE HOME CARE SANTA ROSA LLCFACILITY NUMBER:
494700063
ADMINISTRATOR/
DIRECTOR:		JESSE WALTERSFACILITY TYPE:
300
ADDRESS:131A STONY CIRCLE, SUITE 532TELEPHONE:
(707) 360-1669
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY: CENSUS: DATE:
04/09/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Kim ScottTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti, arrived at the business office of Hillendale Home Care Santa Rosa for an initial inspection on 4/9/25. Upon arrival, the HCSB analyst identified himself and was greeted by Kim Scott. 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 Kim that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Ramsey Chimienti
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2025
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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