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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 304700017
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:48:27 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/07/2025 04:48 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:COMFORT KEEPERS #608FACILITY NUMBER:
304700017
ADMINISTRATOR/
DIRECTOR:		KAREN S. BRUMMFACILITY TYPE:
300
ADDRESS:18351 BEACH BLVD. STE. HTELEPHONE:
(714) 846-3535
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY: CENSUS: DATE:
01/07/2025
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:Karen Brumm, Licensee TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Enforcement Analyst (EA), Mila Quinto, with the Home Care Services Branch (HCSB) conducted an on site inspection for the purpose of a biennial visit. The EA met with designee, Arleen Medina. Licensee, Karen Brumm arrived shortly after. The EA observed the posting of the license and operating business hours. Business operating hours are from 8:30am-5pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records including fingerprint status', registry status', Tuberculosis (TB), and required training. The HCO’s business records were also reviewed during the visit.

Based on the file review, EA informed the licensee of the deficiency found and explained they would be noted on the 809D.

EA provided a copy of the report to the licensee via email.

LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 01/07/2025 04:48 PM - It Cannot Be Edited


Created By: Mila Quinto On 01/07/2025 at 03:54 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

FACILITY NAME: COMFORT KEEPERS #608
FACILITY NUMBER: 304700017

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/14/2025
Section Cited
1796.45
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1796.45 TB Testing (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.
This requirement is not met as evidenced by
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Based on file review, HCA 1 and HCA 4 did not have record of tb clearance on file.
This poses an immediate health and safety risk to clients in care.
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Type A
01/14/2025
Section Cited
1796.31(a)
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1796.31 Home Care Aide Renewal(a) To remain on the home care aide registry, a registered home care aide shall renew his or her registration every two years.
This requirement is not met as evidenced by:
Based on file review, HCA 6 registry was closed.
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This poses an immediate safety risk to the 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: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/07/2025 04:48 PM - It Cannot Be Edited


Created By: Mila Quinto On 01/07/2025 at 04:11 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

FACILITY NAME: COMFORT KEEPERS #608
FACILITY NUMBER: 304700017

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/14/2025
Section Cited
1796.45(c)
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1796.45 TB Testing(c) After submitting to an examination, an affiliated home care aide whose test for tuberculosis infection is negative shall be required to undergo an examination at least once every two years. Once an affiliated home care aide has a documented positive test for tuberculosis infection that has been followed by an X-ray, the examination is no longer required.
This requirement is not met as evidenced by:
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Based on file review, HCA2 and HCA3 did not have a current tb clearance on file.
This poses a potential safety risk to clients in care.
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Type B
01/14/2025
Section Cited
1796.44(a)
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1796.44 Training Requirements(a) A licensee shall ensure that prior to providing home care services, an affiliated home care aide shall complete the training requirements specified in this section.
This requirement is not met as evidenced by:
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Based on file review HCA1 and HCA 9 did not have proof of entry level training.
This poses a potential health and safety risk of 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: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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