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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 514700003
Report Date: 03/20/2024
Date Signed: 03/20/2024 11:51:15 AM

Document Has Been Signed on 03/20/2024 11:51 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:ACTI-KARE RESPONSIVE IN-HOME CAREFACILITY NUMBER:
514700003
ADMINISTRATOR:TAGIMACRUZ, MARIAFACILITY TYPE:
300
ADDRESS:820 BOWEN CTTELEPHONE:
(530) 933-3601
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: CENSUS: DATE:
03/20/2024
Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria TagimacruzTIME COMPLETED:
12:15 PM
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Home Care Services Bureau (HCSB) analyst, Todd Borcher, arrived at the business office of Acti-Kare Responsive In-Home Care for a Two-Year Licensing inspection on March 20, 2024 at approximately 11:00 a.m. Upon arrival, the HCSB analyst identified himself and was greeted by Licensee Maria Tagimacruz. 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 Licensee and informed the Licensee that no discrepancies were found. A copy of the report was provided with appeal rights. Exit interview was conducted.
LICENSING EVALUATOR NAME: Todd Borcher
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
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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