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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 364700130
Report Date: 05/13/2026
Date Signed: 05/13/2026 04:43:35 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/13/2026 04:43 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:AMPLE HOMECAREFACILITY NUMBER:
364700130
ADMINISTRATOR/
DIRECTOR:		HARRISON, LEWINFACILITY TYPE:
300
ADDRESS:2545 CHINO HILLS PKWY STE DTELEPHONE:
(855) 480-2223
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY: CENSUS: DATE:
05/13/2026
Required - 2 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Lewin Harrison, Licensee TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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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 licensee, Lewin Harrison. Per virtual tour of the facility, EA observed the posting of the license and operating business hours. Business operating hours are from 9:00am - 6:00pm, Monday through Friday.

During the inspection, EA reviewed the requirements for Home Care Aides (HCAs) including fingerprint status, HCA registry status, Tuberculosis (TB), and required training(s). EA also reviewed the HCO’s dishonesty bond document. He is in the process or renewing his liability insurance and worker's compensation. Licensee stated he has not hired any staff(HCAs) nor clients since he never started the business.

Based on information reviewed during today's inspection visit, EA informed the licensee of the deficiency found and noted on the 809D. An exit interview was conducted, a copy of the reports (HCS809 & HCS809D) and appeal rights were provided to licensee, Lewin Harrison, via email.

NAME OF LICENSING PROGRAM ANALYST: Jane Cong-Huyen
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2026
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 05/13/2026 04:43 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 05/13/2026 at 11:44 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: AMPLE HOMECARE
FACILITY NUMBER: 364700130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/29/2026
Section Cited
1796.42
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A home care organization licensee shall do all of the following:
(a) Post its license, business hours, and any other information required by the department in its place of business in a conspicuous location, visible both to clients and affiliated home care aides.
(b) Maintain and abide by a valid workers’ compensation policy covering its affiliated home care aides.
(c) Maintain and abide by an employee dishonesty bond, including third-party coverage, with a minimum limit of ten thousand dollars ($10,000).
(d) Maintain proof of general and professional liability insurance in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the aggregate.
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This requirement is not met as evidence by:
Based on interview, HCO did not have the worker's compensation andliability insurance available for review.
This poses a potential health and safety risk to 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: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2026
LIC809 (FAS) - (06/04)
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