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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 424700037
Report Date: 07/07/2026
Date Signed: 07/07/2026 02:37:42 PM

Document Has Been Signed on 07/07/2026 02:37 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:COMPANION CARE HOME HEALTH, LLCFACILITY NUMBER:
424700037
ADMINISTRATOR/
DIRECTOR:		DEANNE OLIVERAFACILITY TYPE:
300
ADDRESS:410 OAK HILL TER.TELEPHONE:
(805) 294-0274
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: CENSUS: DATE:
07/07/2026
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Deanne OliveraTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of Companion Care Home Health for an in-person biennial inspection on 7/7/2026. Upon arrival, the HCSB analyst identified himself and was greeted by Deanne Olivera. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with the licensee. The analyst informed Deanne of the deficiencies found and explained they would be noted on the 809D.
NAME OF LICENSING PROGRAM ANALYST: Ruben Perez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2026
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 07/07/2026 02:37 PM - It Cannot Be Edited


Created By: Ruben Perez On 07/07/2026 at 02:25 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: COMPANION CARE HOME HEALTH, LLC
FACILITY NUMBER: 424700037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/21/2026
Section Cited
1796.45
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(a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease. TB clearance was not documented in the personnel records of caregiver(s) REF# 01,02,03, in the 859-report reviewed by the Enforcement Analyst. Failure to maintain documentation of TB clearance poses an immediate health and safety risk to clients in care.
Type A
07/21/2026
Section Cited
1796.43
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(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. Proof of Clearance was not documented in the personnel records of caregiver(s) REF# 02, in the 859-report reviewed by the Enforcement Analyst. Failure to maintain documentation showing proof of clearance for all home care aides poses an immediate 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: Ruben Perez
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2026
LIC809 (FAS) - (06/04)
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