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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 344700040
Report Date: 04/22/2026
Date Signed: 05/20/2026 10:11:43 AM

Document Has Been Signed on 05/20/2026 10:11 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:GOLDEN YEARS HOME CARE SOLUTIONS, INC.FACILITY NUMBER:
344700040
ADMINISTRATOR/
DIRECTOR:		BALLARD, CARRIEFACILITY TYPE:
300
ADDRESS:8920 EMERALD PARK DR., STE D1TELEPHONE:
(916) 333-0383
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: CENSUS: DATE:
04/22/2026
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Danielle Aderemi TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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Enforcement Analyst (EA) Megan Vigil, with the Home Care Services Branch (HCSB), accompanied by Enforcement Bureau Chief (EBC) Marisa Stone, conducted an onsite inspection and met with the Licensee, Ken Ballard and Designee Toluwanimi "Danielle" Aderemi. Designee completed the file review. During the inspection, the EA verified the posting of the license, observed the operation of the business, and confirmed compliance with insurance requirements. During the visit, EA Vigil determined that the Home Care Organization (HCO) was not in compliance with applicable sections of Health and Safety Code deficiencies were cited list on the 9099D.

Licensee Ken Ballard was interviewed by Enforcement Bureau Chief Marisa Stone and Enforcement Analyst Megan Vigil. During the interview, technical assistance was provided, information was reviewed, and clarification regarding compliance requirements was given.

An exit interview was conducted, and copies of this report, the staff records review report, and information regarding appeal rights were provided.
NAME OF LICENSING PROGRAM ANALYST: Megan Vigil
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2026
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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Document Has Been Signed on 05/20/2026 10:11 AM - It Cannot Be Edited


Created By: Megan Vigil On 04/22/2026 at 11:57 AM
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: GOLDEN YEARS HOME CARE SOLUTIONS, INC.
FACILITY NUMBER: 344700040

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/15/2026
Section Cited
1796.44
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...(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:...
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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: Megan Vigil
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2026
LIC809 (FAS) - (06/04)
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