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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 574700002
Report Date: 10/28/2024
Date Signed: 10/28/2024 02:49:29 PM

Document Has Been Signed on 10/28/2024 02:49 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:AMADA SENIOR CAREFACILITY NUMBER:
574700002
ADMINISTRATOR/
DIRECTOR:		ANGELO OLIVAFACILITY TYPE:
300
ADDRESS:803 2ND ST STE DTELEPHONE:
(530) 338-3225
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: CENSUS: DATE:
10/28/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Angelo OlivaTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Enforcement Analyst (EA), Megan Vigil, with the Home Care Services Branch (HCSB) conducted an onsite inspection. EA Vigil met with Licensee, Angelo Oliva.

During the inspection, the EA observed the posting of the license, operating business, and verified insurance requirements. EA Vigil reviewed the personnel records to complete the file review.

During today’s visit, EA Vigil, found the HCO complied and no deficiencies were cited. An exit interview was conducted, a copy of this report, staff records review report and the appeal rights were provided to Licensee, Angelo Oliva.

LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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