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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 414700094
Report Date: 06/24/2026
Date Signed: 06/24/2026 09:59:45 AM

Document Has Been Signed on 06/24/2026 09:59 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:CARING AND PAIRINGFACILITY NUMBER:
414700094
ADMINISTRATOR/
DIRECTOR:		RAGOOBEER, JASMINAFACILITY TYPE:
300
ADDRESS:619 IVY DRIVETELEPHONE:
(650) 462-1366
CITY:MENLO PARKSTATE: CAZIP CODE:
94025
CAPACITY: CENSUS: DATE:
06/24/2026
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Jasmina RagoobeerTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
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Enforcement Analyst (EA) Ruben Perez conducted an in-person visit and met with the licensee Jasmina Ragoobeer. During the visit, EA verified the posting of the license, observed the operation of the business, confirmed compliance with insurance requirements, reviewed payroll documentation and completed the required personnel file review. All requested documentation was provided and reviewed.

After reviewing all personnel files, the analyst identified deficiencies that were noted on the 809D. An exit interview was conducted, and copies of 809 Facility Evaluation, 859 Staff Records Review Report, and appeal rights information were provided via email.

NAME OF LICENSING PROGRAM ANALYST: Ruben Perez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2026
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 06/24/2026 09:59 AM - It Cannot Be Edited


Created By: Ruben Perez On 06/24/2026 at 09:38 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: CARING AND PAIRING
FACILITY NUMBER: 414700094

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/08/2026
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 REF# 1, 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
07/08/2026
Section Cited
1796.44
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(c) In addition to the requirements in subdivision (b), an affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific, which shall include, but not be limited to, the following areas:
(1) Clients’ rights and safety.
(2) How to provide for, and respond to, a client’s daily living needs.
(3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) If transportation services are provided, how to safely transport a client.
(6) The special care needs of clients with dementia. Training requirements were not documented in the personnel record of caregiver REF# 1, in the 859-report reviewed by the Enforcement Analyst. Failure to maintain documentation of completed training 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: 06/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2026
LIC809 (FAS) - (06/04)
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