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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700025
Report Date: 04/04/2025
Date Signed: 04/04/2025 10:40:16 AM

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
01/08/2025 and conducted by Evaluator Ryan Chan
COMPLAINT CONTROL NUMBER: 47-HC-20250108123625
FACILITY NAME:COMFORT KEEPERS #237FACILITY NUMBER:
194700025
ADMINISTRATOR:ERIN BECKFACILITY TYPE:
300
ADDRESS:420 W BASELINE RD STE DTELEPHONE:
(909) 625-6151
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:CENSUS: DATE:
04/04/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Michael Craig, Licensee and Charlie Lopez, Care ManagerTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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HCO is not providing services to client as contracted.
INVESTIGATION FINDINGS:
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Enforcement Analyst (EA), Ryan Chan, with the Home Care Services Branch (HCSB) conducted a follow-up onsite inspection for the purpose of delivering the findings of a complaint investigation. The EA met with the HCO representatives named above and discussed the allegation.

During the course of the investigation, EA conducted interviews with HCO staff and CalPERS representative. EA reviewed documents including but not limited to: client care agreement which indicates that if client requests a reduction of services or hours after a caregiver receives the schedule, the client will pay for the hours as scheduled, additionally, it indicates the Plan of Care may change based on client requests and service needs. EA reviewed the client assessment and care plan documenting services to be provided to client. EA reviewed HCA orientation packets documenting their roles as caregivers, scheduling, 911 and non-911 procedures.

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

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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-20250108123625
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: COMFORT KEEPERS #237
FACILITY NUMBER: 194700025
VISIT DATE: 04/04/2025
NARRATIVE
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page 2

EA also reviewed client’s power of attorney documents, doctor’s note, care logs, and billing invoices. The HCO has these policies and procedures in place that the HCO reviews with their clients and HCAs. The HCO appears to be adhering to its policies and procedures.

Based on evidence gathered through interviews and records review, the preponderance of evidence standard has not been met, therefore the above allegation is 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 licensee.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Ryan Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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