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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 504700003
Report Date: 07/30/2024
Date Signed: 07/30/2024 04:06:53 PM

Document Has Been Signed on 07/30/2024 04:06 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:ADDUS HOMECAREFACILITY NUMBER:
504700003
ADMINISTRATOR/
DIRECTOR:		DENISE ORDONIEZFACILITY TYPE:
300
ADDRESS:3501 COFFEE ROAD, SUITE 3TELEPHONE:
(630) 296-3400
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: CENSUS: DATE:
07/30/2024
Sub-OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Dorthea WhiteTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Associate Government Program Analyst (AGPA) Megan Vigil, arrived at the business office located at 1325 Howe Ave. Ste. 201 Sacramento, CA 95825. AGPA Vigil was greeted by Dorthea White, Office Coordinator. AGPA Vigil observed the posted license and operating hours and verified there are no folders/files stored in the office. The office is only used for Home Care Aide (HCA) training, recruitment, and exchange of HCA personnel documents. The location is complaint within the operating requirements as a sub-office approved by the Department.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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