214700009-2-5-2026-47-HC-YHAN-DQYQJM-20260204111259

Community Care Licensing

HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 214700009
Report Date: 01/27/2026
Date Signed: 02/05/2026 01:36:55 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/05/2026 01:36 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:	HOMEWELL CARE SERVICES		FACILITY NUMBER:	214700009
ADMINISTRATOR/ DIRECTOR:	LESLIE REESE		FACILITY TYPE:	300
ADDRESS:	813 D STREET		TELEPHONE:	(415) 309-7023
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:		CENSUS:	DATE:	01/27/2026
	Required - 2 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Leslie Reese		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

NARRATIVE

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Enforcement Analyst (EA) Yolanda Hankerson met with the licensee to conduct an enforcement visit (biennial). During the visit, the licensee provided documentation for caregiver files and license requirements. Upon review, the Home Care Organization (HCO) was missing required training records and current TB clearance documentation in multiple caregiver files. In one instance, TB test results were not maintained in the caregiver file and were only located in an email.

The licensee requested additional time to locate missing documentation, stating that the staff member responsible for records was hospitalized. The EA granted an extension until Friday to submit the outstanding items. As of the follow-up date, the requested documentation had not been fully provided. Some items remained missing, including required training records, and TB tests required needed to be replaced with a doctors visit.

An exit interview was conducted with the licensee. The licensee was advised that the deficiencies would be cited. The licensee was provided copies of the 809, the 809D, and Appeal Rights form (LIC 508).

A follow-up was conducted, and the HCS 9099D was sent. The Department is awaiting the licensee’s signature. Deficiencies remain uncorrected at this time and HCO is working to turn in the missing items

NAME OF LICENSING PROGRAM ANALYST: Yolanda Hankerson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/27/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

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 02/05/2026 01:36 PM - It Cannot Be Edited

Created By: Yolanda Hankerson On 01/29/2026 at 05:07 PM

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: HOMEWELL CARE SERVICES	FACILITY NUMBER: 214700009
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/27/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/06/2026 Section Cited 1796.45	1 2 3 4 5 6 7	(a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.(b) For purposes of this section, “examination” means a test for...
	8 9 10 11 12 13 14	(d) After each examination, an affiliated home care aide shall submit, and the home care organization shall keep on file, a certificate from the examining practitioner showing that the affiliated home care aide was examined and found free from active tuberculosis disease.(e) The examination is a condition of initial and continuing employment with the home care organization.(f) An affiliated home care aide who transfers employment from one home care organization to another shall be deemed to meet the requirements of subdivision (a) or (c) if the affiliated home care aide can produce a certificate showing that he or she submitted to the examination within the past two years and was found to be free of active tuberculosis disease, or if it is verified by the home care organization previously employing him or her that it has a certificate on file that contains that showing and a copy of the certificate is provided to the new home care organization prior to the affiliated home care aide beginning employment.Which poses an immediate Health and Safety	8 9 10 11 12 13 14
Type B 03/02/2026 Section Cited 1796.44	1 2 3 4 5 6 7	a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shallcomplete the training requirements specified in this section.(b) An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presencewith a client, as follows... Two hours of orientation training regarding his or her role as caregiver and the applicable terms ofemployment. (2) Three hours of safety training, including basic safety precautions, emergency procedures, and infectioncontrol.(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of fivehours of annual training. The annual training shall relate to core competencies and be population specific, whichshall include, but not be limited to, the following areas: (1) Clients’ rights and safety. (2) How to provide for, and respond to, a client’s daily living needs. (3) How to report, prevent, and detect abuse and neglect. (4) How to assist a client with personal hygiene and other home care services. (5) If transportation services are provided, how to safely transport a client.(d) The entry-level training and annual training described in subdivisions (b) and (c) may be completed through anonline training program. (Amended by Stats. 2015, Ch. 303, Sec. 296. (AB 731) Effective January 1, 2016.)
	8 9 10 11 12 13 14	Two hours of orientation training regarding his or her role as caregiver and the applicable terms ofemployment. (2) Three hours of safety training, including basic safety precautions, emergency procedures, and infectioncontrol.(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of fivehours of annual training. The annual training shall relate to core competencies and be population specific, whichshall include, but not be limited to, the following areas: (1) Clients’ rights and safety. (2) How to provide for, and respond to, a client’s daily living needs. (3) How to report, prevent, and detect abuse and neglect. (4) How to assist a client with personal hygiene and other home care services. (5) If transportation services are provided, how to safely transport a client.(d) The entry-level training and annual training described in subdivisions (b) and (c) may be completed through anonline training program. (Amended by Stats. 2015, Ch. 303, Sec. 296. (AB 731) Effective January 1, 2016.)	8 9 10 11 12 13 14

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: Yolanda Hankerson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

LIC809 (FAS) - (06/04)

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