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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426081
Report Date: 08/13/2025
Date Signed: 08/13/2025 12:29:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
04/25/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250425114731
FACILITY NAME:COMFORT HOME 2FACILITY NUMBER:
366426081
ADMINISTRATOR:LAL, HARISH K.FACILITY TYPE:
740
ADDRESS:7092 PROVIDENCE WAYTELEPHONE:
(909) 371-3427
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:6CENSUS: 6DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Anayeli Hoyos - CaregiverTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Illegal Eviction. Regarding the allegation “Illegal Eviction” LPA conducted an interview with Staff #1 who informed LPA that Resident #1 was no longer living at the facility. Staff #1 further explained that facility was no longer able to meet R#1 care needs as R#1 had a change in condition and due to that reason as of 4/24/2025 R#1 was evicted. During record review pertaining to R#1 LPA discovered that an eviction notice was not on file. LPA asked Staff #1 for the eviction notice and LPA was informed that a notice was not provided to the resident or R#1 responsible party. Staff #1 further explained that the eviction process was discussed verbally with R#1 POA, the facility administrator and R#1 social worker.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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 5
Control Number 56-AS-20250425114731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: COMFORT HOME 2
FACILITY NUMBER: 366426081
VISIT DATE: 08/13/2025
NARRATIVE
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Throughout the review of records and observation it was discovered that the facility did not provide resident (R#1) or resident’s responsible party a written eviction notice discussing the reason of the eviction in addition, the facility did not seek licensing approval for the eviction. Based on the evidence gathered during the investigation, the above allegation is Substantiated.

Substantiated A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, Eviction Procedures 87224(a)(2) from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided, along with a copy of the appeal rights to Facility Administrator.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20250425114731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: COMFORT HOME 2
FACILITY NUMBER: 366426081
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2025
Section Cited
CCR
87224(a)(2)
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Eviction Procedures...(a) A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility to another facility or to an independent living arrangement as a result of the forfeiture of a license.... (2) Provide each resident or the resident’s responsible person with a written notice no later than 60 days before the intended eviction. The notice shall include all of the following.

This requirement is not met as evidence by:
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The licensee has agreed to read over the "Eviction Procedures" regulation and provide a written statement that indicates the acknowledgement after the review of the regulation. The acknowledgement shall be reviewed and signed by all facility staff associated to the facility. The licensee will send the acknowledgement to LPA via email on 8/22/2025.
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Based on observation, and record review, the licensee did not ensure to follow eviction procedures for 1 out of 1 resident, which poses an immediate Health, Safety, or Personal Rights 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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
04/25/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250425114731

FACILITY NAME:COMFORT HOME 2FACILITY NUMBER:
366426081
ADMINISTRATOR:LAL, HARISH K.FACILITY TYPE:
740
ADDRESS:7092 PROVIDENCE WAYTELEPHONE:
(909) 371-3427
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:6CENSUS: 6DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Anayeli Hoyos - CaregiverTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff did not ensure residents care needs were being met.
Staff use chemical restraint on residents in care.
Staff does not ensure needs assesment plans are documented for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Caregiver Anayeli Hoyos and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Staff did not ensure residents care needs were being met. Regarding the allegation stated above LPA conducted interviews with Residents #2-6 regarding the allegation and all residents interviewed informed LPA that their care needs are met daily and that they have no issues or concerns to report. In addition, Resident #4, and Resident #5 informed LPA that they have not witness any mistreatment and that they feel safe at the facility. LPA conducted interviews with Staff #1 and Staff #2 regarding the allegation stated above and Staff #1-2 informed LPA that every resident’s needs are met daily based on each individual need of the resident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20250425114731
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: COMFORT HOME 2
FACILITY NUMBER: 366426081
VISIT DATE: 08/13/2025
NARRATIVE
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Second allegation: Staff use chemical restraint on residents in care. Regarding the allegation stated above LPA conducted a review of record pertaining to R#1 LPA observed medication that all medication pertaining to R#1 was prescribed by R#1 health provider in addition, LPA observed that medication that was prescribed to R#1 was being administered based on medication orders. LPA conducted interviews with Residents #2-6 regarding the allegation stated above and Resident #3 Resident #4 and Resident #5, informed LPA that staff administer their medication based on medication orders. Furthermore, Resident #3 Resident #4 and Resident #5, stated that they have not witnessed staff to over medicate residents or utilize medication as a chemical restraint. All residents informed LPA of feeling safe and not having any issues or concerns. LPA conducted interviews with staff regarding the allegation stated above and Staff #1 and Staff #2 informed LPA that all medication that is administered to the resident is given based on the medication orders. Staff #1 and Staff #2 informed LPA that they have not witness staff to use chemical restraint on residents in care. In addition, Staff #1 and Staff #2 also informed LPA that they have not witness any staff to over medicate a resident[s] in care.

Third allegation: Staff does not ensure needs assessment plans are documented for residents in care. Regarding the allegation stated above LPA requested documentation pertaining to R#1 during the review of records LPA discovered that R#1 assessment plan were on file. During the review of records LPA also discovered that all documentation pertaining to needs and care for R#1 was on file. LPA conducted a file review and observed that 6 out of 6 residents files were complete and all files obtained an individual care plan along with the needs and services for each resident in care. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.

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 (LIC 9099) was discussed, and a copy was provided to Facility Caregiver Anayeli Hoyos at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5