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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 574700015
Report Date: 10/15/2024
Date Signed: 10/16/2024 08:49:17 AM

Document Has Been Signed on 10/16/2024 08:49 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:CIRCLE OF LIFE CAREFACILITY NUMBER:
574700015
ADMINISTRATOR/
DIRECTOR:		NIXON, CHIMENEFACILITY TYPE:
300
ADDRESS:1855 BLOWERS DRTELEPHONE:
(530) 554-5614
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY: CENSUS: DATE:
10/15/2024
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:NIXON, CHIMENETIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Enforcement Analyst (EA), Megan Vigil, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a post licensing. The EA met with Licensee, Chimene Nixon.

During the inspection, the EA observed the posting of the license and operating business hours which show the business operates from 2-5pm Mon-Wed. EA Vigil, reviewed the personnel records for licensee. There are not other staff. Furthermore, EA, reviewed the HCO’s business records including training agenda, abuse reporting incidents, current designee and insurance requirements.

During today’s visit, EA Vigil, found the HCO was in compliance 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 the Licensee.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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