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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701015
Report Date: 05/13/2026
Date Signed: 05/22/2026 08:28:28 AM

Document Has Been Signed on 05/22/2026 08:28 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:EXTENDED FAMILY CAREGIVING, LLCFACILITY NUMBER:
194701015
ADMINISTRATOR/
DIRECTOR:		EMILIO COVARRUBIASFACILITY TYPE:
300
ADDRESS:5 RIDGEWOOD CTTELEPHONE:
(626) 890-1216
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY: CENSUS: DATE:
05/13/2026
OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Emilio Covarrubias - LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Home Care Services Branch (HCSB), Enforcement Analyst (EA) Ryan Chan spoke to licensee Emilio Covarrubias to conduct a telephone pre-inspection interview. The licensee is due for a biennial visit and has agreed to a virtual visit with EA. The virtual visit is scheduled for 5/22/26 at 9:30am via Microsoft Teams.
NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2026
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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