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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530109
Report Date: 03/24/2026
Date Signed: 03/24/2026 03:59:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/08/2025 and conducted by Evaluator Becky Mann
COMPLAINT CONTROL NUMBER: 56-AS-20250908135452
FACILITY NAME:A & A COMFORT CARE LLCFACILITY NUMBER:
365530109
ADMINISTRATOR:HAZAMEH, AHMADFACILITY TYPE:
740
ADDRESS:17455 MADRONE ST.TELEPHONE:
(951) 332-1095
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:6CENSUS: 3DATE:
03/24/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sara Cardenas, CaregiverTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Licensee retained resident requiring a higher level of care
Licensee did not ensure staff were appropriately trained to provide care to residents
Licensee did not ensure staff met required personnel qualifications
Licensee did not ensure staff obtained a criminal record clearance prior to working
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Sara Cardenas, Caregiver and explained the purpose of the visit. The investigation consisted of LPA pertinent record reviews, observations and interviews with staff and residents.

The allegation that Licensee retained resident requiring a higher level of care. Based on LPA observations, interviews and record reviews, the facility has a Dementia Care Plan build into their Plan of Operations. LPA interviewed two (2) staff and they stated that they are trained to assist residents with Dementia.

The allegation that Licensee did not ensure staff were appropriately trained to provide care to residents. LPA reviewed two (2) staff files and they have completed the required trainings to assist residents with Dementia. LPA interviewed two (2) staff and they stated that they are fully trained to assist residents with Dementia.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
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 2
Control Number 56-AS-20250908135452
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: A & A COMFORT CARE LLC
FACILITY NUMBER: 365530109
VISIT DATE: 03/24/2026
NARRATIVE
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The allegation that Licensee did not ensure staff met required personnel qualifications. LPA reviewed two (2) staff files, the staff has their completed health screenings with their TB results. They have their fingerprints background clearance to work at the facility. The staff are CPR certified.

The allegation that Licensee did not ensure staff obtained a criminal record clearance prior to working. LPA reviewed two (2) staff files and they are eligible for their criminal record clearance to work at the facility.

Based on evidence obtained during this investigation, the allegations above are Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and a copy of this report was provided to Sara Cardenas, Caregiver at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2