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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 194700559
Report Date: 01/25/2024
Date Signed: 02/14/2024 11:26:13 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
04/26/2023 and conducted by Evaluator Wendy Her
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20230426150931
FACILITY NAME:COMFORT KEEPERSFACILITY NUMBER:
194700559
ADMINISTRATOR:MAX SNITKOVSKYFACILITY TYPE:
300
ADDRESS:8632 S SEPULVEDA BLVD, STE 103TELEPHONE:
(310) 474-5544
CITY:LOS ANGELESSTATE: ZIP CODE:
90045
CAPACITY:CENSUS: DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Max SnitkovskyTIME COMPLETED:
10:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
HCA's administering medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/25 at 9:55AM, Home Care Service Analyst (HCSA) Wendy Her conducted a phone interview and spoke with licensee Max Snitkovsky.

HCSA reviewed the Home Care Organization’s Training Plans and asked the licensee if Home Care Aides were providing medical services, such as administering medication to clients. Licensee stated no, there are no medical services being provided.

Based on the HCSA’s interview conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, HCS 9099, and appeal rights provided by email, and licensee was told to sign and send back to Home Care Services Bureau.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Chong Vang
LICENSING EVALUATOR NAME: Wendy Her
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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