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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 494700062
Report Date: 10/16/2025
Date Signed: 10/21/2025 07:11:03 AM

Document Has Been Signed on 10/21/2025 07:11 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:PRESTIGE IN HOME CAREFACILITY NUMBER:
494700062
ADMINISTRATOR/
DIRECTOR:		MEREANI IKANIVEREFACILITY TYPE:
300
ADDRESS:1364 NORTH MCDOWELL BLVD STEA2TELEPHONE:
(707) 774-1424
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: CENSUS: DATE:
10/16/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Sophia RogoimuriTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Home Care Services Bureau (HCSB) analyst, Ruben Perez, arrived at the business office of Prestige In Home Care for an initial inspection on 10/16/2025. Upon arrival, the HCSB analyst identified himself and was greeted by Sophia Rogoimuri. 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 designee. The analyst informed Sophia 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: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2025
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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Document Has Been Signed on 10/21/2025 07:11 AM - It Cannot Be Edited


Created By: Ruben Perez On 10/16/2025 at 02:02 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: PRESTIGE IN HOME CARE
FACILITY NUMBER: 494700062

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2025
Section Cited
1796.44 (a)
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Health and Safety Code § 1796.44 (a) A home care organization licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
A record of completion of the required training hours and topics was not documented in any of the caregiver’s personnel records that were reviewed by HCSB analyst. This poses a potential health and safety risk to clients in care.

Type B
10/30/2025
Section Cited
1796.42 (b)
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(b) Maintain and abide by a valid workers’ compensation policy covering its affiliated home care aides.
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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: 10/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2025
LIC809 (FAS) - (06/04)
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