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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 364700157
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:47:22 PM

Document Has Been Signed on 02/18/2025 04:47 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 CHOICE HEALTHCAREFACILITY NUMBER:
364700157
ADMINISTRATOR/
DIRECTOR:		JUSTIN LARSENFACILITY TYPE:
300
ADDRESS:6729 HERMOSA AVE. #201TELEPHONE:
(323) 272-2446
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY: CENSUS: DATE:
02/18/2025
Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Joyce Garcia, DesigneeTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Enforcement Analyst (EA), Jane Cong-Huyen arrived at the business office of Comfort Choice Healthcare. for a Post Licensing Inspection. Upon arrival, EA Cong-Huyen was greeted by the designee, Joyce "JJ" Garcia. The proper posting of business hours and license was observed. Designee provided current proof of professional liability policy, worker's compensation, and dishonesty bond which are current. Business operating hours are from 9am-5pm, Monday thru Friday.

During the inspection, the EA reviewed personnel records for 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.



Based on the file review, EA informed the licensee of the deficiencies found and explained they would be noted on the 809D pages. An exit interview was conducted, a copy of this report (HCS809), staff records review (HCS 859) and appeal rights were provided to the licensee/HCO representative, Joyce Garcia, via email.

EA provided a copy of the report to the licensee via email.
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 02/18/2025 04:47 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 02/18/2025 at 04:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: COMFORT CHOICE HEALTHCARE
FACILITY NUMBER: 364700157

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/19/2025
Section Cited
1796.23(a)
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1796.23(a) - Fingerprint Clearance: Each person initiating a background examination to be a registered home care aide shall submit their fingerprints to the Department of Justice by electronic transmission in a manner approved by the department, unless exempt under subdivision (d). This requirement is not met as evidence by:
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Based on files reviewed, HCA # 2,3,6,7,8,9,10 does not have fingerprint clearance. Licensee was not aware that some staff needed fingerprint clearance.
This poses an immediate health & safety risk to clients in care.
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Type A
02/19/2025
Section Cited
1796.14 (b)
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1796.14 (b) HCA Registry: An affiliated home care aide shall be listed on the home care aide registry prior to providing home care services to a client. This requirement is not met as evidence by: based on file review. HCA # 2,3,6,7,8,9,10 did not a valid home care registry. This poses an immedicate health & safety code to clients 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.
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/18/2025 04:47 PM - It Cannot Be Edited


Created By: Jane Cong-Huyen On 02/18/2025 at 04:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: COMFORT CHOICE HEALTHCARE
FACILITY NUMBER: 364700157

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2025
Section Cited
1796.44 (b)
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1796.44 (b) Training Requirements: An affiliated home care aide shall complete a minimum of five hours of entry-level training prior to presence with a client, as follows:
(1) Two hours of orientation training regarding his or her role as caregiver and the applicable terms of employment.
(2) Three hours of safety training, including basic safety precautions, emergency procedures, and infection control. This requirement is not met as evidence by: based on file review. HCA #2,3,4,5,6,8,10 does not have required training. This poses a potential risk to the health & safety of clients.
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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.
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
LIC809 (FAS) - (06/04)
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