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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 334700191
Report Date: 08/13/2025
Date Signed: 08/13/2025 03:17:02 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/13/2025 03:17 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:INLAND VALLEY COMPANION CAREFACILITY NUMBER:
334700191
ADMINISTRATOR/
DIRECTOR:		LAWTON, BOLIVIAFACILITY TYPE:
300
ADDRESS:26010 MCCALL BLVD STE CTELEPHONE:
(951) 267-6273
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY: CENSUS: DATE:
08/13/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Leslie Gudmundsson, Office ManagerTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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 2 year required licensing visit. The EA met with HCO representative, Leslie Gudmundsson (Office Manager). The EA observed the posting of the license and operating business hours. Business operating hours are from 9am-5pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records for licensee and Home Care Aides including fingerprint status, registry status, Tuberculosis (TB), and required training(s). EA also reviewed the HCO’s business records including document for designee in the absence of the licensee and insurance 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. An exit interview was conducted, a copy of this report (HCS809), staff records review (HCS 859) and appeal rights were provided to the HCO representative, Leslie Gudmundsson, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2025
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 08/13/2025 03:17 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 08/13/2025 at 02:26 PM
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: INLAND VALLEY COMPANION CARE
FACILITY NUMBER: 334700191

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/14/2025
Section Cited
1796.43 (a)
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1796.43 (a): Home care organizations that employ affiliated home care aides shall ensure the affiliated home care aides are cleared on the home care aide registry before placing the individual in direct contact with clients.
This requirement is not met as evidenced by:
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Based on record reviews and interviews. Licensee did not ensure that home care aides (HCA) staff #2 & #5 were cleared on the home care registry before placing them with clients which poses an immediate risk to the health and safety of clients in care.
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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: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/13/2025 03:17 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 08/13/2025 at 02:56 PM
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: INLAND VALLEY COMPANION CARE
FACILITY NUMBER: 334700191

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2025
Section Cited
1796.44(c)
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1796.44(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific, which shall include, but not be limited to, the following areas:
(1) Clients’ rights and safety.
(2) How to provide for and respond to a client’s daily living needs.
(3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) If transportation services are provided, how to safely transport a client.
(d) The entry-level training and annual training described in subdivisions (b) and (c) may be completed through an online training program.
This requirement is not met as evidenced by:
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Based on records reviewed licensee did not ensure home care aides (S2, S3, S5) completed annual training which poses a potential risk to the health and safety of clients in care.
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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: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2025
LIC809 (FAS) - (06/04)
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