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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700314
Report Date: 03/26/2026
Date Signed: 03/26/2026 11:58:36 AM

Document Has Been Signed on 03/26/2026 11:58 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: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:
03/26/2026
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Aida Samson, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Enforcement Analyst (EA), Joshua Rarela, with the Home Care Services Branch (HCSB) conducted a virtual Biennial Inspection of the Home Care Organization (HCO) listed above.

During the inspection, the EA observed the posting of the license and operating business hours. The EA reviewed the personnel records for the licensee, staff, and Home Care Aides, including Criminal Record Clearance, Home Care Aide Registry Status and HCO Associations, Tuberculosis Test Results, and mandatory entry and annual training history. Furthermore, the EA reviewed the HCO’s business records, including the training agenda, current designee, and insurance requirements, such as the professional liability policy, worker's compensation, and dishonesty bond.

The EA found the HCO in compliance, and no deficiencies were cited. A copy of this report, the staff records review report, and appeal rights were provided to the Home Care Organization.
NAME OF LICENSING PROGRAM ANALYST: Joshua Rarela
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2026
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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