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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700041
Report Date: 07/01/2024
Date Signed: 07/01/2024 12:58:24 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/01/2024 12:58 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 KEEPERSFACILITY NUMBER:
374700041
ADMINISTRATOR/
DIRECTOR:		MOURA EVERHARTFACILITY TYPE:
300
ADDRESS:9747 PROSPECT AVE. STE 203TELEPHONE:
(619) 444-3200
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: CENSUS: DATE:
07/01/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Adina DexterTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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Home Care Services Bureau (HCSB) Analyst Adrian Mangina arrived at the business office of Comfort Keepers on July 1, 2024 for a Biennial inspection. Upon arrival, the HCSB analyst identified herself and was greeted by Julie Hopkins-Wright, Client Care Manager and Adina Dexter, HR Administrator. The proper posting of business hours and license were observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Analyst observed current insurance and dishonesty bond. Analyst advised that all TB tests must be performed within 90 days before hire or 7 days after. Upon completion of the file review the analyst discussed the findings of the inspection with the Designees. The analyst informed the representatives named above of the deficiencies found and explained they would be noted on the HCS809-D form. In addition, the Designee was provided a copy of the HCS9058 Appeal Rights form.
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2024
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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Document Has Been Signed on 07/01/2024 12:58 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 07/01/2024 at 12:28 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 KEEPERS
FACILITY NUMBER: 374700041

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2024
Section Cited
1796.44(c)
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1796.44(c) ... affiliated home care aide shall complete a minimum of five hours of annual training. The annual training shall relate to complete a minimum of five hours of annual training. The annual training shall relate to core competencies and be population specific, which shall include, but not be limited to, the following areas:
(1) Clients’ rights and safety.
(2) How to provide for and respond to a client’s daily living needs.
(3) How to report, prevent, and detect abuse and neglect.
(4) How to assist a client with personal hygiene and other home care services.
(5) If transportation services are provided, how to safely transport a client...
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This requirement was not met as evidenced by:
During the review of files, it was observed that reference #1, #5, and #6 did not have current TB test a finding which poses a potential health and safety risk to persons 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: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2024
LIC809 (FAS) - (06/04)
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