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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700746
Report Date: 07/23/2025
Date Signed: 07/23/2025 02:56:54 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/19/2025 and conducted by Evaluator Ryan Chan
COMPLAINT CONTROL NUMBER: 47-HC-20250619100502
FACILITY NAME:PRESTIGE HOME CARE ANGELS INC.FACILITY NUMBER:
194700746
ADMINISTRATOR:XOCHITL GARCIAFACILITY TYPE:
300
ADDRESS:2130 HUNTINGTON DR. STE 211TELEPHONE:
(626) 460-6555
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY:CENSUS: DATE:
07/23/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Evelyn Acevedo - Care CoordinatorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Home Care Aides have not completed the required training hours
HCO is not providing services to client as contracted
INVESTIGATION FINDINGS:
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On 7/23/25, Home Care Services Branch Enforcement Analyst (EA), Ryan Chan conducted a follow up investigation visit regarding the above complaint allegations, EA met with Care Coordinator Evelyn Acevedo.

Reporting party (RP) alleges the home care aids (HCA) assigned to a client did not have the proper training and did not provide services to the client as contracted. During the investigation EA conducted interviews, reviewed training logs, and reviewed the client’s care plan. Interviews conducted indicate that the care plan was discussed with the HCA and that the training required was provided before the HCA was placed with the client.



(See pg 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 47-HC-20250619100502
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME: PRESTIGE HOME CARE ANGELS INC.
FACILITY NUMBER: 194700746
VISIT DATE: 07/23/2025
NARRATIVE
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Page 2

The Department has investigated the complaint with the allegations listed above. Based on interviews conducted and documents reviewed, EA concluded that there was not enough evidence to show that the organization violated any of the allegations listed above, therefore, the above allegations are found to be UNSUBSTANTIATED.

EA concluded the visit with an exit interview and provided a copy of this report along with appeal rights to the designee.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2