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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 074700056
Report Date: 07/24/2025
Date Signed: 07/28/2025 11:11:43 AM

Document Has Been Signed on 07/28/2025 11:11 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:PENNY'S IN-HOME CARE SERVICES, INC.FACILITY NUMBER:
074700056
ADMINISTRATOR/
DIRECTOR:		GARDNER, JOSEFINAFACILITY TYPE:
300
ADDRESS:990 ROSEHEDGE CT.TELEPHONE:
(925) 286-0424
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: CENSUS: DATE:
07/24/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Josephina Gardner TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Enforcement Analyst (EA) Megan Vigil, with the Home Care Services Branch (HCSB), conducted an onsite inspection. The EA met with the licensee Josephina Gardner.

During the inspection, the EA verified the posting of the license, observed the operation of the business, and confirmed compliance with insurance requirements.

During the visit, EA Vigil determined that the Home Care Organization (HCO) was not in compliance with applicable sections of Health and Safety Code deficiencies were cited. An exit interview was conducted, and copies of this report, the staff records review report, and information regarding appeal rights were provided.
NAME OF LICENSING PROGRAM ANALYST: Megan Vigil
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 07/28/2025 11:11 AM - It Cannot Be Edited


Created By: Megan Vigil On 07/24/2025 at 10:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: PENNY'S IN-HOME CARE SERVICES, INC.
FACILITY NUMBER: 074700056

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/31/2025
Section Cited
1796.43
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...(a) Home care organizations that employ
affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients...
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Home Care Aides (HCAs) were not cleared or deemed eligible on the Home Care Aide Registry prior to providing services to the public. This poses an immediate health and safety risk to clients in care.
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Type A
07/31/2025
Section Cited
1796.45
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...(d) After each examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from active tuberculosis disease…
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The Home Care Organization (HCO) did not have tuberculosis (TB) test records on file for its Home Care Aides (HCAs). This poses an immediate health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/28/2025 11:11 AM - It Cannot Be Edited


Created By: Megan Vigil On 07/24/2025 at 11:13 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
Although this visit/inspection may have focused on the review of specific licensing requirements, the applicant/licensee must comply with all applicable requirements. The California Department of Social Services retains authority to issue citations or take disciplinary action for any deficiency.


FACILITY NAME: PENNY'S IN-HOME CARE SERVICES, INC.
FACILITY NUMBER: 074700056

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2025
Section Cited
1796.44
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(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements in this section. (b) An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to
presence with a client, as follows:
(1) Two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control.
(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific, which shall include, but
not be limited to, the following areas:
(1) Clients’ rights and safety.(2) How to provide for, and respond to, a client’s
daily living needs. (3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) If transportation services are provided, how to safely transport a client.
(d) The entry-level training and annual training
described in subdivisions (b) and (c) may be
completed through an online training program.
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The Enforcement Analyst was unable to review completed training requirements assigned to the home care aides before providing services to the public. This poses a potential health and
safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2025
LIC809 (FAS) - (06/04)
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