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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700273
Report Date: 05/20/2025
Date Signed: 05/20/2025 03:42:08 PM

Document Has Been Signed on 05/20/2025 03:42 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:FAMILY GOLDEN CARE SERVICESFACILITY NUMBER:
304700273
ADMINISTRATOR/
DIRECTOR:		RUBY LYNN CRUZFACILITY TYPE:
300
ADDRESS:10212 MALINDA LNTELEPHONE:
(714) 244-5885
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: CENSUS: DATE:
05/20/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Ruby Lynn Cruz, DesigneeTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Enforcement Analysts (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on-site inspection for the purpose of a post licensing visit. The EA met with the designee, Ruby Cruz. The EA observed the posting of the license and operating business hours. Business operating hours are from 9:00 am -4:00pm, 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 HCO’s business records were also reviewed during the visit including, the insurance requirements.

Based on the file review, EA informed the designee of the following violation observe and being cited in accordance with Health and Safety Code. See HCS809D.

An exit interview was conducted, a copy of this report (HCS809), staff records review (HCS 859) and appeal rights were provided to the licensee representative, Ruby Cruz via email.
NAME OF LICENSING PROGRAM ANALYST: Mila Quinto
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2025
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 05/20/2025 03:42 PM - It Cannot Be Edited


Created By: Mila Quinto On 05/20/2025 at 02:51 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: FAMILY GOLDEN CARE SERVICES
FACILITY NUMBER: 304700273

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/27/2025
Section Cited
1796.31(a)
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1796.31(a) To remain on the home care aide registry, a registered home care aide shall renew his or her registration every two years.
This requrement is not met as evidenced by:
Based on file review, HCA 1 did not have a current registry on home care registry.
This poses an immediately health and safety risk to clients in care.
Type A
05/27/2025
Section Cited
1796.45(a)
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1796.45 TB Testing(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.
This requirement is not met as evidenced by:
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Based on interview and file review, HCA1 did not have the tb clearance on file available 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: 05/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/20/2025 03:42 PM - It Cannot Be Edited


Created By: Mila Quinto On 05/20/2025 at 03:16 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: FAMILY GOLDEN CARE SERVICES
FACILITY NUMBER: 304700273

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/27/2025
Section Cited
1796.44(a)
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1796.44(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.
This requirement is not met as evidenced by:
Based on file review, HCA1 and HCA2 did not have the training record for review.
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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: 05/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2025
LIC809 (FAS) - (06/04)
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