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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700443
Report Date: 07/30/2026
Date Signed: 07/30/2026 11:32:46 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/30/2026 11:32 AM - 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:AT HOME VA STAFFING LLCFACILITY NUMBER:
304700443
ADMINISTRATOR/
DIRECTOR:		RUTH TIMAFACILITY TYPE:
300
ADDRESS:1303 W VALENCIA DR #310TELEPHONE:
(213) 326-7452
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: CENSUS: DATE:
07/30/2026
Required - 2 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Derian Ruth Williams King - Operation ManagerTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Enforcement Analysts (EAs), Jane Cong-Huyen and Mila with the Home Care Services Branch (HCSB), conducted an onsite inspection for the purpose of a biennial licensing visit. EA met with Derian Ruth Williams King, Operation Manager. EA observed the posting of the license and operating business hours. Business operating hours are from 9:00am – 4:00pm, Monday through Friday.

During the inspection, EA reviewed personnel records for staff and Home Care Aides (HCAs) including fingerprint status, HCA registry status, Tuberculosis (TB), and required training(s). EA also reviewed the HCO’s business records for insurance requirements and document for the designee in the absence of the licensee.

EA Cong-Huyen found the HCO in compliance and no deficiencies were cited. An exit interview was conducted, and a copy of this report (HCS809) was provided to the Operation Manager, Derian Ruth Williams King, via email.
Jane Cong-Huyen
DATE: 07/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2026
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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