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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 364700154
Report Date: 01/28/2025
Date Signed: 01/28/2025 12:12:01 PM

Document Has Been Signed on 01/28/2025 12:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:COMFORT KEEPERS #308FACILITY NUMBER:
364700154
ADMINISTRATOR/
DIRECTOR:		CAROLYN HAGANFACILITY TYPE:
300
ADDRESS:31629 OUTER HWY. 10 S, #FTELEPHONE:
(909) 798-1199
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY: CENSUS: DATE:
01/28/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Carolyn Hagen, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Enforcement Analyst (EA), Jane Cong-Huyen, with the Home Care Services Branch (HCSB) conducted an onsite inspection for the purpose of a Post Licensing visit at the business office of Comfort Keepers #308. The EA met with HCO representative, Carolyn Hagan. The EA observed the posting of the license and operating business hours. Business operating hours are from 8:00am-4:30pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records for licensee, staff and Home Care Aides including fingerprint status, registry status, Tuberculosis (TB), and required training(s). The HCO’s business records including document for designee in the absence of the licensee and insurance requirements were also reviewed during the visit.

EA Cong-Huyen found the HCO in compliance and no deficiencies were cited. An exit interview was conducted, a copy of this report (HCS809), staff records review (HCS 859) were provided to the HCO representative, Carolyn Hagan, via email.
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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