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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881130
Report Date: 09/15/2025
Date Signed: 09/15/2025 04:17:06 PM

Unsubstantiated


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
09/25/2022 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20220925095710
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: 6DATE:
09/15/2025
UNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Christian CourtTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff did not prevent an altercation between residents.
Staff refused to allow resident to return from the hospital
INVESTIGATION FINDINGS:
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On September 15, 2025, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above listed allegations and to deliver findings. The Department was met by Christian Court and the purpose of the visit was explained.

Investigation consisted of the following:
On 10/4/22, the Department conducted an unannounced initial visit to facility to investigate the complaint allegations mentioned above. It was determined that the complaint required further investigation.

On 9/15/25 the Department obtained and reviewed the following documents: Unusual Incident Report (UIR) dated 9/23/22 , Staff Roster (dated 6/22/25), Client Roster (dated 10/23/24), C1’s conservatorship document (dated 8/29/22), C1’s Physician’s report (dated 7/26/22), C1’s medication list, C1’s personal rights (dated 11/1/21), C1’s Pre-placement appraisal (11/1/21), C1’s admission agreement (dated 11/1/21), Staff training--client’s rights (8/22/25), S1 Advance National Caregiver Certification (dated 7/15/20)
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
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 3
Control Number 18-AS-20220925095710
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: 09/15/2025
NARRATIVE
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Investigation revealed the following:

Allegation: Staff did not prevent an altercation between residents

The detail of the complaint alleges that “C1 was transferred via AMR to RUHS on 09/23/22 because C1 was struck in the face by roommate.”

On 9/15/25 at 12:17pm, the Department interviewed the Administrator (A1) regarding the allegation above. A1 denied the allegation, stating that a staff member was present when the altercation occurred and de-escalated the situation. A1 went on to state that his staff are trained to properly address behaviors of the clients in care.

On 9/15/25, between 1:00pm and 2:30pm, the Department interviewed 2 staff regarding the above allegation, and of those interviewed 2 out of 2 were not around during this incident, they were hired after it occurred. However, they stated that in general, staff are always around and they intervene and de-escalate situations as they occur. Additionally, 2 of the 2 staff interviewed state that they receive training on how to handle client behaviors in the home.

On 9/15/25, LPA obtained, reviewed and evaluated the following documents: Staff training (dated 7/15/20 and 8/22/25), which indicated that staff are trained to handle client behaviors in the home. Lastly, 2 out of 2 staff interviewed stated that there are sufficient staff to meet the client’s needs.

Based on interviews conducted, and documents reviewed, there is insufficient evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20220925095710
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: 09/15/2025
NARRATIVE
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Allegation: Staff refused to allow resident to return from the hospital

The detail of the complaint alleges that “C1 was discharged and medically cleared, however, A1 refuses to take the client home."

On 9/15/25 at 12:17pm, the Department interviewed Administrator (A1) regarding the allegation above. A1 denied the allegation stating he never refused to allow client to return from the hospital. A1 further explained that on 9/23/22, C1 was transported RUHS medical Center instead of RUHS Psychiatric Hospital--the desired location due to C1’s behaviors. A1 stated, “they wouldn’t do it, I just wanted them transport C1 to the proper place, but the hospital wanted to discharge C1. Lastly, A1 stated that "they threatened me saying I am abandoning C1, which was not true.” C1’s conservator reportedly had to intervene to get C1 transported to the requested psychiatric facility.

On 9/15/25, between 1:00pm and 2:30pm, the Department interviewed 2 staff regarding the above allegation, and of those interviewed. 2 out of 2 could not provide any information regarding the incident as they were hired after the incident occurred.

On 9/15/25, the Department obtained reviewed and evaluated the following documents: Unusual Incident Report (UIR) dated 9/23/22 , Staff Roster (dated 6/22/25), Client Roster (dated 10/23/24), C1’s conservatorship document (dated 8/29/22), C1’s Physician’s report (dated 7/26/22), C1’s medication list (3/27/24), C1’s personal rights (dated 11/1/21), and C1’s Pre-placement appraisal (11/1/21).

Based on interviews conducted, and documents reviewed, there is insufficient evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

There were no deficiencies cited during today's visit. Exit interview conducted and a copy of the report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
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