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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364700157
Report Date: 05/08/2024
Date Signed: 05/10/2024 10:31:27 AM

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
02/20/2024 and conducted by Evaluator Megan Vigil
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20240220091916
FACILITY NAME:COMFORT CHOICE HEALTHCAREFACILITY NUMBER:
364700157
ADMINISTRATOR:JUSTIN LARSENFACILITY TYPE:
300
ADDRESS:6729 HERMOSA AVE. #201TELEPHONE:
(323) 272-2446
CITY:RANCHO CUCAMONGASTATE: ZIP CODE:
91701
CAPACITY:CENSUS: DATE:
05/08/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Justin LarsenTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Business is operating an unlicensed Home Care Organization.
INVESTIGATION FINDINGS:
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Associate Government Program Analyst (AGPA) Vigil spoke to Licensee over the phone to discuss the allegation above.

Licensee, Justin Larsen stated they operate an active hospice license, verified through California Department of Public Health license # 550006030, facility ID 630020124. The Organization is exempt from licensure per Health and Safety Code 1796.45, Article 2, Section 1796.17 (b)(2). However, Licensee obtained the Home Care Organization License 364700157 in addition to/separate from the hospice license for the purposes of providing non-medical services to the public.

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. An exit interview was conducted, a copy of the 9099 report and appeal rights were provided.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wendy Scott
LICENSING EVALUATOR NAME: Megan Vigil
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
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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