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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425978
Report Date: 02/20/2026
Date Signed: 02/20/2026 11:30:20 AM

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
07/28/2023 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20230728091428
FACILITY NAME:LIVE IN COMFORT CAREFACILITY NUMBER:
336425978
ADMINISTRATOR:GOMEZ, KECIAFACILITY TYPE:
740
ADDRESS:9872 WOODBRIDGE LANETELEPHONE:
(909) 643-6965
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:6CENSUS: 5DATE:
02/20/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Staff Isabel CantuTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Resident sustained severe injuries due to staff neglect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit for the purpose of delivering findings for allegation listed above. LPA met with Staff Isabel Cantu explained the purpose of the visit. LPA contacted Licensee Jose Gomez via telephone to inform of today's visit.

On 07/28/2023, the Department received a complaint pertaining to a resident sustaining severe injuries due to staff neglect. The Department’s investigation consisted of review of facility files, other pertinent records, observations, and interviews with pertinent individuals.

Per facility interviews, it was discovered that Resident #1 (R1) fell during the night on 07/13/2023 and sustained a C1 fracture and a broken nose. The Department observed through facility records that the facility staff responded to R1’s fall and contacted emergency services immediately and R1 was transported to the hospital. Additionally, R1 did not require one on one care supervision.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
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-20230728091428
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: LIVE IN COMFORT CARE
FACILITY NUMBER: 336425978
VISIT DATE: 02/20/2026
NARRATIVE
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Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is no preponderance of the evidence to prove that the alleged violation occurred.

During today’s visit, no deficiencies pertaining to the allegations were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Staff Isabel Cantu and Licensee Jose Gomez. Licensee informed LPA that Staff Isabel Cantu is able to sign reports due to Licensee not being able to come to facility.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2