425801777-5-13-2026-29-AS-KKOS-DU2VS6-20260513164100

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425801777
Report Date: 05/13/2026
Date Signed: 05/13/2026 04:43:04 PM

Document Has Been Signed on 05/13/2026 04:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	COMFORTS OF HOME SENIOR CARE, INC.		FACILITY NUMBER:	425801777
ADMINISTRATOR/ DIRECTOR:	TRINA DELLINGER-GLEISSNER		FACILITY TYPE:	740
ADDRESS:	16 SAN DIMAS AVENUE		TELEPHONE:	(805) 451-5027
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93111
CAPACITY: 6		CENSUS: 5	DATE:	05/13/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:05 AM
MET WITH:	Trina Dellinger-Gleissner, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection to the above-named facility. LPA was greeted by Administrator Trina Dellinger-Gleissner and explained the purpose of the visit. Gary Gleissner, Co-Administrator was also present during the inspection. The facility is a Residential Care Facility for the Elderly (RCFE) and is home to a capacity of 6 residents of which 6 may be non-ambulatory with a dementia diagnosis. There is one resident currently on hospice at this time. Entrance interview conducted: At the time of the arrival, there were five (5) residents in care with Administrators Dellinger-Gleissner and Gleissner on duty. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the facility for fire safety, personal accommodations, and food service. The physical environment was checked for cleanliness and condition. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Cleaning agents are kept in a locked shed outside the facility. Cleaning agents are inaccessible to residents in care. Kitchen trash is kept in a locked cabinet under the kitchen sink. The kitchen, dining area, and common area are neat and clean. The facility has five (5) bedrooms for a capacity of six residents. Bedroom #5 is a shared bedroom with two residents. All of the bedrooms are furnished with lights and nightstand lamps to provide sufficient lighting. There are two bathrooms in the facility available for use to all residents. There are four (4) fire extinguishers last serviced on 3/26/2026. Please continue to 809-C, Pg 2.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMFORTS OF HOME SENIOR CARE, INC.	FACILITY NUMBER: 425801777
	VISIT DATE: 05/13/2026

NARRATIVE

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There is one private bedroom for staff behind the kitchen and laundry area. The facility maintains a comfortable room temperature.
LPA determined there is a sufficient amount of food consisting of two (2) days of perishables and seven (7) days of non-perishables. Snacks and beverages are available for Residents upon request.
The facility has a dual carbon monoxide/smoke detector system with eight (8) detectors throughout the facility. The system is in good working order.
Inventory of Medication Administration Record (MAR) and residents’ medications revealed Resident 1’s (R1’s) Levothyroxine 100mcg had an unexplainable overcount of one (1) tablet and Resident 2’s (R2’s) Carbidopa Levodopa 25 100mg had an unexplainable undercount of three (3) tablets.
Residents’ records were reviewed. Copies of Residents’ Admission Agreements, Physician’s Report, Health Screenings, Appraisals, and Needs and Services were on file.
Personnel records were reviewed and records and trainings are up to date. All persons associated with the facility have criminal record clearances and have been properly associated to the facility.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted. Copy of report and Appeal Rights issued at the time of the visit.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/13/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/13/2026 04:43 PM - It Cannot Be Edited

Created By: Kristin Kontilis On 05/13/2026 at 04:25 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMFORTS OF HOME SENIOR CARE, INC.	FACILITY NUMBER: 425801777
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87465(c)(2)

87465(c)(2) Incidental and Medical Care: ....Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above when there was an unexplainable overcount of one (1) of R1’s prescribed medications and an undercount of three (3) of R2’s medications which poses an immediate health and safety risk to residents in care.
	POC Due Date: 05/15/2026
	Plan of Correction
1 2 3 4	Administrator agrees to conduct a review of medication administration procedures with all staff no later than POC due date. Administrator agrees to submit a written plan in place to ensure medications are given as prescribed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:

	Kristin Kontilis
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/13/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

LIC809 (FAS) - (06/04)

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