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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701015
Report Date: 05/22/2026
Date Signed: 05/22/2026 02:17:51 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/22/2026 02:17 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: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:
05/22/2026
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Emilio Covarrubias - LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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Enforcement Analyst (EA), Ryan Chan, with the Home Care Services Branch (HCSB) conducted a virtual visit for the purpose of a biennial inspection, EA met with the licensee Emilio Covarrubias. The proper posting of business hours and license was observed during the virtual tour of the facility.

During the inspection, EA reviewed personnel records for Home Care Aides (HCA) including fingerprint status', registry status', tuberculosis (TB), and required training. The Home Care Organization’s (HCO’s) business records were also reviewed during the visit including the insurance requirements. Upon completion of the file review EA discussed the findings of the inspection with the licensee and informed him of the deficiencies found and explained they would be noted on the 809D. EA advised that home care aides (HCA)s who are not cleared on the HCA Registry are not to be with clients.

An exit interview was conducted, a copy of this report and appeal rights were provided to the licensee via email.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2026
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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Document Has Been Signed on 05/22/2026 02:17 PM - It Cannot Be Edited


Created By: Ryan Chan On 05/22/2026 at 09:37 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: EXTENDED FAMILY CAREGIVING, LLC
FACILITY NUMBER: 194701015

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/22/2026
Section Cited
1796.43(a)
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1796.43 (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.
This requirement is not met as evidenced by:

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Based on records reviewed licensee did not ensure home care aide (HCA) staff S1 was cleared on the HCA Registry before placing S1 in direct contact with clients which poses an immediate risk to the health and safety of 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: Ryan Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2026
LIC809 (FAS) - (06/04)
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