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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334700162
Report Date: 04/08/2026
Date Signed: 04/08/2026 12:22:33 PM

Substantiated


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
03/30/2026 and conducted by Evaluator Jane Cong-Huyen
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20260330084810
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:
04/08/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rosanna "Rose" Her, LicenseeTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Home Care Aide is not approved on the Home Care Aide Registry
INVESTIGATION FINDINGS:
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On 4/8/26, Home Care Services Branch Enforcement Analyst (EA), Jane Cong-Huyen conducted a complaint investigation visit regarding the above complaint allegation. Upon arrival, EA met with the licensee, Rose Her. During today's visit, EA conducted interview and gathered information relating to the allegation above. Ms. Her stated that staff #1 was a volunteer. She provided private care for her own mother for a few months in 2025 and did not provide care to clients from the home care organization. Staff #1 has moved to another state and is no longer volunteering for her since mid 2025. Ms. Her stated she thought since staff #1 was a volunteer and she was a CNA at one point; she never checked or requested home care aide registry. She admitted to writing a letter of recommendation for staff #1 for job purposes.
Based on records reviewed and interview conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Health and Safety Code, Division 2, Chapter 13, Section 1796.14(b) is being cited on the attached HCS 9099D. EA concluded the visit with an exit interview and provided a copy of this report along with appeal rights to Ms. Her, via email.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 47-HC-20260330084810
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HOMECARE
FACILITY NUMBER: 334700162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2026
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 evidenced by:
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Licensee will not place any HCA/staff/volunteer with clients until HCA/staff/volunteer has been approved with HCA Registry and has fingerprint clearance. Licensee will submit a statement to CDSS stating she understands and agrees to never allow any staff member or volunteer to be
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Based on records reviewed and interview, licensee did not ensure staff #1 (a volunteer ) to be cleared with home care aide registry prior to be being placed to work with client(s), which poses an immediate risk to the health and safety of the clients in care.
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placed with clients unless they are fingerprint cleared and HCA registered to Jane.cong-huyen@dss.ca.gov by 4/9/2026.
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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.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
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