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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334700162
Report Date: 05/28/2025
Date Signed: 05/28/2025 02:01:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2025 and conducted by Evaluator Jane Cong-Huyen
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250414100430
FACILITY NAME:EVERWELL HOMECAREFACILITY NUMBER:
334700162
ADMINISTRATOR:HER, ROSANNAFACILITY TYPE:
300
ADDRESS:12 S. SAN GORGONIO AVE # 204TELEPHONE:
(909) 658-5382
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:CENSUS: DATE:
05/28/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rose Her, LicenseeTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
HCO did not ensure that staff are being properly trained.
HCO providing medical services to clients.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/28/25, Home Care Services Branch Enforcement Analyst (EA), Jane Cong-Huyen conducted an investigation visit regarding the above complaint allegations. Upon arrival, HCSA met with the licensee, Rose Her.
The Department has investigated the complaint with the allegations listed above. Based on interviews, file reviews, HCA training document with curriculum, client's contract, care logs/notes, and other related document reviews. EA concluded that there was not enough evidence to show that the HCAs are not properly trained and that they are providing medical services such as changing the catheters, using the inhailer/nebulizer machine and/or other medical services provided to the clients. Therefore, there is not enought evidence to show that the HCO has violated the above allegations and it is found to be UNSUBSTANTIATED.
EA concluded the with an exit interview and provided a copy of this report along with appeal rights to the licensee, Rose Her.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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