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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364700080
Report Date: 05/12/2025
Date Signed: 05/12/2025 01:15:44 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/08/2025 and conducted by Evaluator Jane Cong-Huyen
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20250408145913
FACILITY NAME:COMFORCARE HOME CARE-RANCHO CUCAMONGAFACILITY NUMBER:
364700080
ADMINISTRATOR:DAVIS, SHAYFACILITY TYPE:
300
ADDRESS:600 N MOUNTAIN AVE, STE B-200TELEPHONE:
(909) 932-1110
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:CENSUS: DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Rachel DavisTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
HCO is not providing services to client as contracted.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/12/2025, Home Care Services Branch Enforcement Analysts (EAs), Jane Cong-Huyen and Mila Quinto conducted a complaint visit to deliver the finding for the above complaint allegation. Upon arrival, EAs met with the licensee, Rachel Davis.
The Department has investigated the complaint with the allegation listed above. Based on staff interviews and review of evidence: contract agreement, care plan, care logs, client’s billing statement, and client notes of the incident date; EAs concluded that there was not enough evidence to show that the organization has violated the above allegation. The client was billed for few specific hours under administrative time spent to locate another HCA to cover the night shift on 4/4/25-4/5/25 which was interrupted by an altercation between the HCA and the client’s family member. Therefore, based upon the information gathered, the billing for those specific hours were justifiable and the above allegations is found to be UNSUBSTANTIATED.
EAs concluded the visit with an exit interview and provided a copy of this report (HCS9099) along with appeal rights (HCS9058) to the licensee, Rachel Davis.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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