<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700976
Report Date: 12/03/2025
Date Signed: 12/03/2025 09:31:06 AM

Document Has Been Signed on 12/03/2025 09:31 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:HOME CAREGIVER COMPANIONFACILITY NUMBER:
194700976
ADMINISTRATOR/
DIRECTOR:		JENNIE LAMFACILITY TYPE:
300
ADDRESS:16881 SIMS LANE #ATELEPHONE:
(310) 648-2177
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY: CENSUS: DATE:
12/03/2025
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Jennie Lam, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB), conducted an on-site inspection for the purpose of a biennial inspection. The EA met with the licensee, Jennie Lam. EA observed the posting of the license and operating business hours. Business operating hours are from 8:00am am -5:00 pm, Mondays.

During the inspection, the EA reviewed personnel records for licensee and business records were also reviewed during the visit including the insurance requirements. According to the licensee, she currently do not have cilents and home care aids at this time.

During today’s visit, EA Quinto found the HCO was in compliance and no deficiencies were cited.

An exit interview was conducted, a copy of this report (HCS809), was provided to the licensee, Jennie Lam via email.
NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2025
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 1