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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 584700001
Report Date: 05/01/2024
Date Signed: 05/01/2024 11:28:57 AM

Document Has Been Signed on 05/01/2024 11:28 AM - 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 KEEPERS #374FACILITY NUMBER:
584700001
ADMINISTRATOR/
DIRECTOR:		NEIL GOFORTHFACILITY TYPE:
300
ADDRESS:901 H STREETTELEPHONE:
(530) 749-8800
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: CENSUS: DATE:
05/01/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Licensee - Neil GoforthTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Home Care Services Branch (HCSB) analysts, Todd Borcher and Sonya Wilson, arrived at the business office of Comfort Keepers #374 for a Two-Year Licensing inspection on May 1, 2024. Upon arrival, the HCSB analysts identified themselves and were greeted by Licensee Neil Goforth. The proper posting of business hours and license was observed. The analysts were then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analysts discussed the findings of the inspection with the Licensee and informed the Licensee that no discrepancies were found. A copy of the report was provided with appeal rights. Exit interview was conducted.
LICENSING EVALUATOR NAME: Todd Borcher
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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