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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364700157
Report Date: 05/19/2026
Date Signed: 05/21/2026 04:36:52 PM

Substantiated


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
04/17/2026 and conducted by Evaluator Jane Cong-Huyen
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20260417091034
FACILITY NAME:COMFORT CHOICE HEALTHCAREFACILITY NUMBER:
364700157
ADMINISTRATOR:JUSTIN LARSENFACILITY TYPE:
300
ADDRESS:6729 HERMOSA AVE. #141TELEPHONE:
(323) 272-2446
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:CENSUS: DATE:
05/19/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Justin Larsen - Licensee (Unavailable to Meet)TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Home Care Aides are providing medical services to clients
INVESTIGATION FINDINGS:
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On 5/19/2026, Home Care Services Branch Enforcement Analyst (EA), Jane Cong-Huyen completed the complaint investigation regarding the above complaint allegation. The home care organization is no longer operating at the address listed above as of 5/11/26. No staff are present at this location.

During the investigation, EA confirmed with staff and observed documentation on the care logs showing the home care aides (HCAs) administered medication to client(s) in care daily.
Based on record reviews and interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Health and Safety Code, Division 2, Chapter 13, Section 1796.12(n) is cited on the attached LIC9099D.

EA Cong-Huyen provided copy of this report along with appeal rights to the licensee, Justin Larsen, via email for signature on each report page. The licensee will send the report pages back to HCSB for the records.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
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 3
Control Number 47-HC-20260417091034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HEALTHCARE
FACILITY NUMBER: 364700157
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2026
Section Cited
1796.12(n)
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1796.12(n) Home care services mean nonmedical services and assistance provided by a registered home care aide to a client who, because of advanced age or physical or mental disability, cannot perform these services. These services...include, but are not limited to, assistance with the following: bathing, dressing, feeding, exercising, personal hygiene and grooming, transferring, ambulating, positioning, toileting and incontinence care, assisting with medication that the client self-administers, housekeeping, meal planning and preparation, laundry, transportation, correspondence, making telephone calls, shopping for personal care items or groceries, and companionship. This subdivision shall not authorize a registered home care aide to assist with medication that the client self-administers that would otherwise require administration or oversight by a licensed health care professional.
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HCO will not provide any medical services including administering medication to client(s) in care. HCO will review CDSS/HCSB Health & Safety Codes and Home Care Services Fact Sheet. HCO license has expired on 5/8/26 and HCO business is currently closed.
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This requirement is not met as evidenced by:
Based on the information obtained, it was determined that HCAs were providing medical services to client(s) on a daily basis. Licensee did not ensure that only nonmedical services were provided to client(s) which poses an immediate risk to the Health and Safety of 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.
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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
04/17/2026 and conducted by Evaluator Jane Cong-Huyen
PUBLIC
COMPLAINT CONTROL NUMBER: 47-HC-20260417091034

FACILITY NAME:COMFORT CHOICE HEALTHCAREFACILITY NUMBER:
364700157
ADMINISTRATOR:JUSTIN LARSENFACILITY TYPE:
300
ADDRESS:6729 HERMOSA AVE. #141TELEPHONE:
(323) 272-2446
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:CENSUS: DATE:
05/19/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Justin Larsen - LicenseeTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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HCO is not providing services to client as contracted
INVESTIGATION FINDINGS:
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On 5/19/2026, Home Care Services Branch Enforcement Analyst (EA), Jane Cong-Huyen completed the complaint investigation regarding the above complaint allegation. The home care organization is no longer operating at the address listed above as of 5/11/26. No staff are present at this location.

It was alleged that the HCO was not providing adequate services to clients. Based on the information obtained during interviews, observations, and documentation reviewed it is determined that there was not enough evidence showing the HCO was not providing adequate services to the client in care.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is found to be UNSUBSTANTIATED and no deficiencies were cited. The licensee, Justin Larsen, will be receiving a copy of this report (HCS 9099) and Appeal Rights via email. The licensee will sign this report and send report back to CDSS/HCSB for the record.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Susan Du
LICENSING EVALUATOR NAME: Jane Cong-Huyen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3