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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194701134
Report Date: 12/19/2025
Date Signed: 12/19/2025 10:15:57 AM

Document Has Been Signed on 12/19/2025 10:15 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:PRISTINE CARE CENTERFACILITY NUMBER:
194701134
ADMINISTRATOR/
DIRECTOR:		SIMMONS, PRINCEFACILITY TYPE:
300
ADDRESS:17777 CENTER CT DR N STE 600TELEPHONE:
(562) 477-0157
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: CENSUS: DATE:
12/19/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Prince Simmons - LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Home Care Services Bureau Enforcement Analyst (EA) Ryan Chan arrived at the business office of Pristine Care Center on 12/19/25 for a post licensing inspection. EA met with licensee Prince Simmons. The proper posting of business hours and license was observed. The proof of insurance records were reviewed. EA was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review EA discussed the findings of the inspection with the licensee and informed him that no discrepancies were found. Licensee stated he did not have any clients and home care aides at this time. EA went over home care aide requirements such as training, tb tests, background checks, home care aide registry, and Guardian.

EA Chan concluded the visit with an exit interview and provided a copy of this report to the licensee.

NAME OF LICENSING PROGRAM ANALYST: Ryan Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2025
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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