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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 504700010
Report Date: 06/16/2023
Date Signed: 06/16/2023 10:37:51 AM

Document Has Been Signed on 06/16/2023 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:INTERIM HOMESTYLE SERVICESFACILITY NUMBER:
504700010
ADMINISTRATOR:RONALD MURPHYFACILITY TYPE:
300
ADDRESS:1521 N. CARPENTER RD, SUITE D2TELEPHONE:
(209) 577-5936
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: CENSUS: DATE:
06/16/2023
Required - 2 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ronald MurphyTIME COMPLETED:
10:45 AM
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Home Care Services Bureau (HCSB) analyst Ruben Perez arrived at the business office of Interim Homestyle Services on 6/16/2023 for a biennial inspection. Upon arrival, the HCSB analyst identified himself and was greeted by Ronald Murphy. 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 Ronald and informed the licensee that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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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