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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 584700002
Report Date: 11/26/2024
Date Signed: 11/26/2024 01:16:16 PM

Document Has Been Signed on 11/26/2024 01:16 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:HELEN'S HOME HEALTH LLCFACILITY NUMBER:
584700002
ADMINISTRATOR/
DIRECTOR:		GIBBS, CARMEN L.FACILITY TYPE:
300
ADDRESS:2428 CANYON CREEK TRAILTELEPHONE:
(916) 835-5827
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY: CENSUS: DATE:
11/26/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Licensee - Carmen GibbsTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Home Care Services Branch (HCSB) Analyst, Todd Borcher, arrived at the business office of Helen's Home Health LLC for a Two-Year Licensing inspection on November 26, 2024. Upon arrival, the Analyst identified himself and was greeted by licensee Carmen Gibbs. 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 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: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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