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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 504700006
Report Date: 06/09/2025
Date Signed: 06/10/2025 07:53:09 AM

Document Has Been Signed on 06/10/2025 07:53 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:COVENANTCARE AT HOMEFACILITY NUMBER:
504700006
ADMINISTRATOR/
DIRECTOR:		RONDA MALMBERGFACILITY TYPE:
300
ADDRESS:125 N. BROADWAY, SUITE 1BTELEPHONE:
(209) 250-5200
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: CENSUS: DATE:
06/09/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Samantha WTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of Covenantcare At Home for a biennial inspection on 6/9/2025. Upon arrival, the HCSB analyst identified himself and was greeted by Samantha W. 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 designee and informed Samantha that no discrepancies were found.
NAME OF LICENSING PROGRAM ANALYST: Ruben Perez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2025
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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