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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 364700001
Report Date: 03/19/2026
Date Signed: 03/19/2026 11:51:52 AM

Document Has Been Signed on 03/19/2026 11:51 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:HOME INSTEAD SENIOR CAREFACILITY NUMBER:
364700001
ADMINISTRATOR/
DIRECTOR:		BRANDI JOHNSONFACILITY TYPE:
300
ADDRESS:13334 AMARGOSA ROADTELEPHONE:
(760) 843-5655
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: CENSUS: DATE:
03/19/2026
Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Nicole Herd, ManagerTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Enforcement Analyst (EA), Jane Cong-Huyen, with the Home Care Services Branch (HCSB) conducted a virtual visit for the purpose of a biennial inspection. EA met with the HCO representative, Nicole Herd. Per virtual tour of the facility, EA observed the posting of the license and operating business hours. Business operating hours are from 8:00am - 4:30pm, Monday and Friday.

During the inspection, EA reviewed personnel records for Home Care Aides (HCAs) including fingerprint status, HCA registry status, Tuberculosis (TB), and required training(s). EA also reviewed the HCO’s business records for insurance requirements.



EA Cong-Huyen found the HCO in compliance and no deficiencies were cited. An exit interview was conducted, and a copy of this report (HCS809) was provided to the HCO representative, Nicole Herd, via email.
NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2026
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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