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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423907
Report Date: 12/14/2021
Date Signed: 12/14/2021 10:46:20 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/08/2021 and conducted by Evaluator Jesse Gardner
COMPLAINT CONTROL NUMBER: 18-AS-20211208135115
FACILITY NAME:COMFORTS OF HOME RESIDENTIAL CARE, LLCFACILITY NUMBER:
336423907
ADMINISTRATOR:CORI COOPERFACILITY TYPE:
740
ADDRESS:74-092 JERI LANETELEPHONE:
(760) 610-1156
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:6CENSUS: 5DATE:
12/14/2021
UNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Ana Ortiz, CaregiverTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility failed to issue a refund of preadmission fee
Facility failed to provide full written disclosure of the preadmission fee charges and refund conditions
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived at the facility unannounced to investigate the above allegations. LPA identified himself and discussed the purpose of the visit with Caregiver Ana Ortiz. Ortiz called their Administrator Cori Cooper, and LPA spoke with them (over telephone).

Through interviews with Witness one (W1) and Administrator, it was determined that Client one (C1) had not been admitted to the facility, the family had not been issued a refund, and the admissions agreement was not a signed document per Title 22 Section 6 Chapter 8 Article 9 Resident Records 87507 Admission Agreements, these allegations were deemed to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted with Caregiver Ana Ortiz and a copy of this report along with LIC9099-D, LIC 811, and Appeal Rights were provided.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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 18-AS-20211208135115
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: COMFORTS OF HOME RESIDENTIAL CARE, LLC
FACILITY NUMBER: 336423907
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2021
Section Cited
CCR
87507
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87507 Admission Agreements
(g) Admission agreements shall specify the following:
(5) Refund conditions.
(E) Preadmission fees shall be refunded...
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Licensee will draft a new admissions agreement to comply with Title 22 and review the regulation, and agrees to provide the applicable refund amount of the preadmission fee to W1. Licensee to provide LPA Gardner with self-certification of the reviewed regulation. Proof requested is due by Plan of Correction date of 12/28/21.
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1. A 100 percent refund of a preadmission fee shall be provided to an applicant...
b. The licensee fails to provide full written disclosure of preadmission fee charges and refund conditions. This requirement was not being met as evidenced by: Through interviews obtained, this poses a potential risk to residents in care.
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Type B
12/28/2021
Section Cited
CCR
87507
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87507 Admission Agreements
(g) Admission agreements shall specify the following:
(5) Refund conditions.
(E) Preadmission fees shall be refunded
(1) A 100 percent refund of a preadmission..
(b) The licensee fails to provide full written disclosure of preadmission fee...
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Licensee to provide LPA Gardner with self-certification of the reviewed regulation. Proof requested is due by Plan of Correction date of 12/28/21.
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b. The licensee fails to provide full written disclosure of preadmission fee charges and refund conditions. This requirement was not being met as evidenced by: Through interviews obtained, this poses a potential risk to residents 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.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2