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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700046
Report Date: 04/02/2025
Date Signed: 04/02/2025 12:18:12 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/02/2025 12:18 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:IM HERE TO HELP YOU, INCFACILITY NUMBER:
334700046
ADMINISTRATOR/
DIRECTOR:		PENELOPE ELLIENFACILITY TYPE:
300
ADDRESS:2794 LARAMIE RDTELEPHONE:
(951) 276-4920
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY: CENSUS: DATE:
04/02/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Penny Ellien, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Enforcement Analyst (EA), Jane Cong-Huyen, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a Required 2 Year Licensing visit. The EA met with licensee, Penny Ellien. The EA observed the posting of the current license and operating business hours: 8am-12pm, Tuesday & Wednesday.

During the inspection, the EA reviewed personnel records for licensee, staff, and HCA staff including fingerprint clearance, HCA Registry, Tuberculosis (TB), and required training. The HCO’s business records including document for designee (HCS308) in the absence of the licensee, insurance, bond and worker's compensation requirements were also reviewed during the visit.

Based on the file review, EA informed the licensee of the deficiencies found and explained they would be noted on the 809D pages. An exit interview was conducted, a copy of this report (HCS809), staff records review (HCS 859) and appeal rights were provided to the licensee, Penny Ellien, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
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 04/02/2025 12:18 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 04/02/2025 at 11:00 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: IM HERE TO HELP YOU, INC
FACILITY NUMBER: 334700046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/03/2025
Section Cited
1796.14 (b)
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1796.14(b) - An affiliated home care aide shall be listed on the home care aide registry prior to providing home care services to a client.
This requirement is not met as evidence by: based on file review. HCA staff #2, #4, & #5 did not a valid home care registry. This poses an immedicate health & safety code to clients in care.
Type A
04/03/2025
Section Cited
1796.23(a)
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1796.23(a) Each person initiating a background examination to be a registered home care aide shall submit their fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d). This requirement is not met as evidence by:
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Based on interviews, HCA staff # 2, #4, & #5 does not have fingerprint clearance.
This poses an immediate health & safety risk to clients in care.
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Type A
04/03/2025
Section Cited
1796.45 (a)
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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.This requirement is not met as evidence by: base on file reviews for HCA Staff #2 & #4 which did not have proof of TB clearance. This poses an immediate Health & Safety risk to clients in care.
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: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/02/2025 12:18 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 04/02/2025 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: IM HERE TO HELP YOU, INC
FACILITY NUMBER: 334700046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2025
Section Cited
1796.44 (b)
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1796.44 (b) Training Requirement: (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 his or her role as caregiver and the applicable terms of employment.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control. This requirement is not met as evidence by: based on file review. HCA #2 does not have required training. This poses a potential risk to the health & safety of clients.
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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: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
LIC809 (FAS) - (06/04)
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