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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700114
Report Date: 04/02/2026
Date Signed: 04/02/2026 11:32:44 AM

Document Has Been Signed on 04/02/2026 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:CAREGIVER PROVIDERFACILITY NUMBER:
334700114
ADMINISTRATOR/
DIRECTOR:		JENNIFER DAINFACILITY TYPE:
300
ADDRESS:31570 RAILROAD CANYON RD #200TELEPHONE:
(951) 246-2550
CITY:CANYON LAKESTATE: CAZIP CODE:
92587
CAPACITY: CENSUS: DATE:
04/02/2026
Annual/RandomANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Jennifer Dain, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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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 biennial licensing visit. EA met with licensee, Jennifer Dain. EA observed the posting of the license and operating business hours. Business operating hours are from 9:00am – 4:00pm, Tuesday - Thursday, Monday - By Appointment Only.

During the inspection, EA reviewed personnel records for 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 licensee, Jennifer Dain, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2026
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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