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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 554700005
Report Date: 09/12/2024
Date Signed: 09/12/2024 05:16:59 PM

Document Has Been Signed on 09/12/2024 05:16 PM - 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:TLC ASSISTANT LIVING SERVICESFACILITY NUMBER:
554700005
ADMINISTRATOR/
DIRECTOR:		HAMPTON, SHELIAHFACILITY TYPE:
300
ADDRESS:20915 O'BRIEN CTTELEPHONE:
(209) 288-2484
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: CENSUS: DATE:
09/12/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Sheliah HamptonTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti, arrived at the business office of TLC Assistant Living Services for a post-licensing inspection on 9/12/24. Upon arrival, the HCSB analyst identified himself and was greeted by Sheliah Hampton. 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 Licensee and informed Sheliah that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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