<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700162
Report Date: 05/28/2025
Date Signed: 05/28/2025 02:03:48 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/28/2025 02:03 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:EVERWELL HOMECAREFACILITY NUMBER:
334700162
ADMINISTRATOR/
DIRECTOR:		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
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Rose Her, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Enforcement Analysts (EA), Jane Cong-Huyen with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a 2 year required licensing visit. The EA met with licensee, Rose Her. The EA observed the posting of the license and operating business hours. Business operating hours are from 12pm - 5pm, .
Wednesdays.

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

EA Cong-Huyen found the HCO in compliance and no deficiencies were cited. An exit interview was conducted, a copy of this report (HCS809) was provided to the licensee/HCO representative, Rose Her, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2025
I acknowledge receipt of this form and understand my 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.

HCS809 (FAS) - (06/04)
Page: 1 of 1