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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 074700200
Report Date: 08/28/2025
Date Signed: 08/29/2025 01:51:55 PM

Document Has Been Signed on 08/29/2025 01:51 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:COMFORTKEEP HOME LLCFACILITY NUMBER:
074700200
ADMINISTRATOR/
DIRECTOR:		JACK CHANFACILITY TYPE:
300
ADDRESS:2001 OMEGA RD STE 202BTELEPHONE:
(510) 388-2355
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: CENSUS: DATE:
08/28/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Jack Chan TIME VISIT/
INSPECTION COMPLETED:
01:55 PM
NARRATIVE
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Enforcement Analyst (EA) Megan Vigil, with the Home Care Services Branch (HCSB), conducted an onsite inspection and met with Licensee Jack Chan.

During the inspection, EA Vigil observed the posting of the license, verified the operation of the business, and confirmed compliance with insurance requirements. Additionally, EA Vigil reviewed personnel records to complete the file review.

At the conclusion of the visit, EA Vigil found the Home Care Organization (HCO) to be in full compliance, with no deficiencies noted. An exit interview was conducted, during which a copy of this report, the staff records review report, and information regarding appeal rights were provided.
NAME OF LICENSING PROGRAM ANALYST: Megan Vigil
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2025
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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