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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 234700001
Report Date: 02/10/2026
Date Signed: 02/24/2026 04:34:22 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/24/2026 04:34 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:GOERTZEN CARE DBA ANDERSSON CAREFACILITY NUMBER:
234700001
ADMINISTRATOR/
DIRECTOR:		AARON GOERTZENFACILITY TYPE:
300
ADDRESS:32924 ODOM LANETELEPHONE:
(707) 964-4040
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY: CENSUS: DATE:
02/10/2026
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Aaron Goertzen TIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Enforcement Analyst (EA), Yolanda Hankerson  arrived at the business office of Goertzen Care DBA Anderson Care . Upon arrival, the Enforcement analyst identified herself and was greeted by Aaron Goertzen . The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with the Licensee. The analyst informed the Licensee of the deficiencies found and explained they would be noted on the 809D. In addition, the Licensee was provided a copy of the LIC 9058 (Applicant/Licensee Rights) form. 
 
NAME OF LICENSING PROGRAM ANALYST: Yolanda Hankerson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2026
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 02/24/2026 04:34 PM - It Cannot Be Edited


Created By: Yolanda Hankerson On 02/10/2026 at 04:40 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: GOERTZEN CARE DBA ANDERSSON CARE
FACILITY NUMBER: 234700001

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/20/2026
Section Cited
1976.45(a)
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Health and Safety Code § 1796.45 (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. TB clearance was not documented in INDICATE_NUMBER of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses an immediate health and safety risk to clients in care.

Type A
02/20/2026
Section Cited
1796.23 (a)
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 Each person initiating a background examination to be a registered home care aide shall submit his or her fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d). Criminal Background Clearance and/or Exemption approval was not obtained for,,,
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#1 and #2 of the caregivers on staff. This poses an immediate health and safety risk to clients in care.

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Type B
03/12/2026
Section Cited
1796.44(a)
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(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete 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 presence with a client, as follows:
(1) Two hours of orientation training regarding their role as home care aide and the applicable terms of employment.
HCA will complete training HCO will provide proof of training
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: 02/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2026
LIC809 (FAS) - (06/04)
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