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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 504700031
Report Date: 11/10/2021
Date Signed: 11/12/2021 08:58:30 AM

Document Has Been Signed on 11/12/2021 08:58 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
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:ALL HEALTH SERVICES DBA CAREGIVER TO YOUFACILITY NUMBER:
504700031
ADMINISTRATOR:MATTHEWS, JEREMY D.FACILITY TYPE:
300
ADDRESS:801 15TH ST. STE BTELEPHONE:
(209) 542-4537
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY: 0CENSUS: DATE:
11/10/2021
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jeremy MatthewsTIME COMPLETED:
10:45 AM
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Home Care Services Bureau (HCSB) Analyst Ruben Perez arrived at the business office of Caregiver to You on 11/10/2021. Upon arrival, the HCSB analyst identified himself and was greeted by Jeremy Matthews. 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 Jeremy and informed him that no discrepancies were found.
LICENSING EVALUATOR NAME: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2021
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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