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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 504700013
Report Date: 12/03/2024
Date Signed: 12/03/2024 10:21:27 AM

Document Has Been Signed on 12/03/2024 10:21 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:VALLEY HOME CAREFACILITY NUMBER:
504700013
ADMINISTRATOR/
DIRECTOR:		KIM URIARTEFACILITY TYPE:
300
ADDRESS:909 15TH ST STE 2TELEPHONE:
(559) 222-0344
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY: CENSUS: DATE:
12/03/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Nancy VenegasTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of Valley Home Care for a biennial inspection on 12/3/2024. Upon arrival, the HCSB analyst identified himself and was greeted by Nancy Venegas. 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 Nancy that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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