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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700078
Report Date: 05/19/2026
Date Signed: 05/19/2026 02:23:05 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/19/2026 02:23 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:ASSURITY HOMECAREFACILITY NUMBER:
304700078
ADMINISTRATOR/
DIRECTOR:		BEN BOLLARDFACILITY TYPE:
300
ADDRESS:9110 IRVINE CENTER DR.TELEPHONE:
(818) 268-1704
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: CENSUS: DATE:
05/19/2026
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ben Bollard, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted a virtual visit for the purpose of a biennial inspection. The EA met with the licensee, Ben Bollard. Per virtual tour of the facility, EA observed the posting of the license and operating business hours. Business operating hours are from 9:00am -5:00 pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records for licensee, and Home Care Aides 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.

Based on the file review, EA informed the licensee of the following violation observe and being cited in accordance with Health and Safety Code; 1796.45(c) TB Clearance, 1796.44(c) Training Requirements, and 1796.44(c) Inspections and Investigations. See HCS809D.



An exit interview was conducted, a copy of this report (HCS809 and HCS 809D), staff records review (HCS 859), and appeal rights were provided to the licensee, Ben Bollard via email.
NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2026
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 3
Document Has Been Signed on 05/19/2026 02:23 PM - It Cannot Be Edited


Created By: Mila Quinto On 05/19/2026 at 11:18 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: ASSURITY HOMECARE
FACILITY NUMBER: 304700078

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2026
Section Cited
1796.45(c)
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1796.45 TB Testing(c) After submitting to an examination, an affiliated home care aide whose test for tuberculosis infection is negative shall be required to undergo an examination at least once every two years.
This requirement is not met as evidenced by:
Based on file review, HCA 1 did not have a current TB clearance.
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This poses an immediate health and safety risk to clients in care.
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Type A
05/26/2026
Section Cited
1796.44(c)
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1796.44 Training Requirements(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific...
This requirement is not met as evidenced by:
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Based on interview and file review, HCA1 did not have the annual training.
This poses an immediate health and safety to 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: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2026
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/19/2026 02:23 PM - It Cannot Be Edited


Created By: Mila Quinto On 05/19/2026 at 11:28 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: ASSURITY HOMECARE
FACILITY NUMBER: 304700078

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2026
Section Cited
5/26/26
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1796.52 Inspections and Investigations(c) An investigation or inspection conducted by the department pursuant to this chapter may include, but is not limited to, inspection of the books, records, or premises of a home care organization. A home care organization’s refusal to make records, books, or premises available shall constitute cause for the revocation of the home care organization’s license.
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This requirement is not met as evidenced by:
Based on interview and file review, HCA2 thru HCA 6 did not have personell files for review.
This poses an immediate health and safety risk to 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: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2026
LIC809 (FAS) - (06/04)
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