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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700314
Report Date: 03/19/2026
Date Signed: 03/19/2026 02:35:41 PM

Document Has Been Signed on 03/19/2026 02:35 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:CRYSTAL CARE SERVICES, LLCFACILITY NUMBER:
194700314
ADMINISTRATOR/
DIRECTOR:		SAMSON, AIDA R.FACILITY TYPE:
300
ADDRESS:3325 MARY STREETTELEPHONE:
(818) 434-7435
CITY:GLENDALESTATE: CAZIP CODE:
91214
CAPACITY: CENSUS: DATE:
03/19/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Aida Samson, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) communicated with the Home Care Organization (HCO) representative named above regarding a Biennial inspection.

The HCO opted for a Virtual Biennial inspection.

The Biennial inspection is tentatively scheduled for March 26, 2026 at 10AM.
NAME OF LICENSING PROGRAM ANALYST: Joshua Rarela
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2026
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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