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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881130
Report Date: 04/09/2024
Date Signed: 04/09/2024 11:01:42 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2024 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240308104344
FACILITY NAME:C & M COMFORT HOMEFACILITY NUMBER:
331881130
ADMINISTRATOR:COURT, CHRISTIANFACILITY TYPE:
735
ADDRESS:24662 MANTEE PLACETELEPHONE:
(951) 378-5820
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:6CENSUS: 5DATE:
04/09/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Christian Court - Licensee/AdministratorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff violated resident's personal rights
Staff did not prevent resident from being harassed by other residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced in order to deliver findings for an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Licensee/Administrator Christian Court. Below is a summary of the complaint investigation findings:

Regarding allegation “Staff violated resident's personal rights”: LPA Colvin conducted interviews with residents and staff as well as conducted a tour of the facility during the investigation. Some of the specific concerns regarding Personal Rights that were reported included: staff moving resident’s items out of their closet/dresser and throwing them on the bed; staff making inappropriate comments to resident; and staff belittling residents. While the evidence collected did not support all of the issues presented under the allegation, there was sufficient evidence through multiple interviews to support that staff, specifically Administrator Christian Court, belittle residents and speaks disrespectfully to them. Therefore, based on interviews conducted, the allegation “Staff violated resident's personal rights” is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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 7
Control Number 18-AS-20240308104344
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: C & M COMFORT HOME
FACILITY NUMBER: 331881130
VISIT DATE: 04/09/2024
NARRATIVE
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Regarding allegation “Staff did not prevent resident from being harassed by other residents”: LPA Colvin conducted interviews with staff and residents in regard to the complaint allegation. Through interviews, LPA Colvin learned that prior to being moved to separate bedrooms, Resident One (R1) was often harassed by another resident (R2), who was her roommate at the time. Harassment suffered by R1 included being locked out of their shared room (resulting in R1 sleeping on the couch for up to one month) and punching R1. Interviews revealed that R2 has also physically attacked other residents, and residents feel uncomfortable around R2. Interviews suggest that staff are aware of R2’s behavior and have not done anything to protect the other residents’ safety and well-being, other than eventually moving R2 into a private bedroom. Therefore, based on information received during the investigation, the allegation “Staff did not prevent resident from being harassed by other residents” is SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Due to observations made by LPA Colvin, the facility was cited, and deficiencies noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, and appeal rights were provided to Licensee/Administrator Christian Court during the exit interview.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 18-AS-20240308104344
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: C & M COMFORT HOME
FACILITY NUMBER: 331881130
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2024
Section Cited
CCR
80072(a)(1)
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Personal Rights: (a)...each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met by:
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Licensee/Administrator agrees to undergo re-training of Personal Rights of Residents. Copy of training (or estimated completion date, follow by proof of training once completed) to be submitted to LPA Colvin by Plan of Correction date of 4/10/24.
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Based on interviews conducted, the Licensee did not comply with the above regulation with one staff member (Administrator). Interviews revealed that S1 does not speak to residents with respect. This is an immediate personal rights violation of residents in care.
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Type A
04/10/2024
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
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Licensee/Administrator agrees to retrain staff on how to handle resident disputes to ensure safety and well-being of all residents. Copy of training (or estimated completion date, follow by proof of training once completed) to be submitted to LPA Colvin by
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Based on interviews, the Licensee did not comply with the above regulation with at least one resident (R1). Interviews reveal that R1 was being harassed by another resident (R2). This was an immediate personal rights violation of R1.
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Plan of Correction date of 4/10/24.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2024 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240308104344

FACILITY NAME:C & M COMFORT HOMEFACILITY NUMBER:
331881130
ADMINISTRATOR:COURT, CHRISTIANFACILITY TYPE:
735
ADDRESS:24662 MANTEE PLACETELEPHONE:
(951) 378-5820
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:6CENSUS: 5DATE:
04/09/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Christian Court - Licensee/AdministratorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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9
Staff member sent resident to day program without her asthma inhaler
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced in order to deliver findings for an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Licensee/Administrator Christian Court. Below is a summary of the complaint investigation findings:

Regarding allegation "Staff member sent resident to day program without her asthma inhaler”: LPA Colvin conducted interviews with residents and staff regarding the allegation. Facility keeps a Medication Administration Log for Resident One’s (R1) inhaler, which reflects daily administration of the medication. Interviews conducted were inconclusive as to if the resident has been sent to day program without their inhaler. Therefore, due to lack of evidence, the allegation “Staff member sent resident to day program without her asthma inhaler” is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 18-AS-20240308104344
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: C & M COMFORT HOME
FACILITY NUMBER: 331881130
VISIT DATE: 04/09/2024
NARRATIVE
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A finding of UNSUBSTANTIATED means 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.

An exit interview was conducted with Licensee/Administrator Christian Court and a copy of this report was provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7