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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700327
Report Date: 07/30/2026
Date Signed: 07/30/2026 08:53:54 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2026 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20260720135205
FACILITY NAME:A & V COMFORT HOME CAREFACILITY NUMBER:
342700327
ADMINISTRATOR:VERES, VASILEFACILITY TYPE:
740
ADDRESS:5604 NORTH AVETELEPHONE:
(916) 487-7015
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
07/30/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Maria VeresTIME COMPLETED:
09:00 AM
ALLEGATION(S):
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Refund not provided after resident passing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cassandra Mikkelson arrived unannounced to deliver findings to allegations listed above. LPA met with Maria Veres,during today’s visit.

During today's inspection LPA conducted interviews, toured the facility and reviewed records pertinent to the investigation.

***Continued on 9099-C page**
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
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 59-AS-20260720135205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: A & V COMFORT HOME CARE
FACILITY NUMBER: 342700327
VISIT DATE: 07/30/2026
NARRATIVE
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Refund not provided after resident passing

Interview conducted indicated that resident R1 moved into the facility on April 1, 2026 and passed away on April 12, 2026. R1 signed the admission agreement on March 31, 2026. The admission agreement signed and agreed upon between the resident and Licensee/facility indicated that the amount of $7,000.00 would be paid each month for rent and care level. R1 was receiving hospice care upon move in which the admission agreement indicated “hospice services: $1,000.00 per day, not to exceed monthly charge”. R1 resided at the facility from April 1, 2026 to April 12, 2026, which exceeded the hospice charge per day, not exceeding the monthly charge rate of $7,000.00. Documents reviewed indicated that the admission agreement was signed by both R1 and a co-signer (R1’s family member). R1 was their own responsible party but R1’s co-signer assisted with decision making. Both signed all sections of the admission agreement in understanding the facility policies. Therefore, the allegation refund not provided after resident passing is unfounded.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2