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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006547
Report Date: 05/26/2026
Date Signed: 05/26/2026 05:06:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/05/2025 and conducted by Evaluator Edward Kim
COMPLAINT CONTROL NUMBER: 22-AS-20250305152012
FACILITY NAME:COMFORT FIRST HOME CAREFACILITY NUMBER:
306006547
ADMINISTRATOR:PHAM, MINHFACILITY TYPE:
740
ADDRESS:645 S MAGNOLIA AVETELEPHONE:
(714) 244-5687
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 4DATE:
05/26/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator- Jenny PhamTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Resident sustained injuries due to neglect/lack of supervision
Resident wandered from the facility due to neglect/lack of supervision
Facility is not maintaining resident's medication records
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Administrator (ADMIN) Jenny Pham and explained the purpose of today’s visit.

The investigation consisted of the following: On March 10, 2025, LPA Kim conducted a health and safety visit with ADMIN Jenny Pham. LPA obtained copies of Rental/Lease Agreements and Hospital Discharge Records of the residents.

The investigation revealed the following:

Allegation: Resident sustained injuries due to neglect/lack of supervision.

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
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 8
Control Number 22-AS-20250305152012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: COMFORT FIRST HOME CARE
FACILITY NUMBER: 306006547
VISIT DATE: 05/26/2026
NARRATIVE
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It I alleged resident #1 (R1) fell outside of the facility and sustained multiple lacerations.

Based on the investigation, record review revealed that Resident 1(R1) had a rental agreement signed on December 5, 2024, with the move in date of October 23, 2024. The facility became licensed on December 13, 2024, however, R1 continued to live in the facility without admission agreement, medical records, plan of care, or appraisal records maintained at the facility. The investigation further revealed that R1 required care and supervision. One staff (S1) stated they provided care to R1 and stated although R1 was considered a tenant, R1 was sometimes confused and required care and supervision. Legacy Home Health also provided care including shower and diaper changes per Witness#1.

Based on interviews conducted, Staff 1 (S1) stated that on March 4, 2025, after preparing dinner in the kitchen, S1 noticed that Resident 1 (R1) was missing from the facility. S1 stated R1 was last seen approximately one hour earlier, and S1 did not notice R1 exit the facility. There was no auditory alarm to alert staff. S1 admitted that after discovering R1 was missing, S1 did not report the incident to law enforcement or R1’s family and only notified the administrator. S2 stated per interview that they do not know if anyone looked for R1 when R1 left the facility. S2 also stated they did not document the incident.

Based on record review, hospital records revealed that on March 4, 2025, at approximately 3:00 PM, Resident 1 (R1) was observed by bystanders walking barefoot in the neighborhood when R1 tripped and fell onto their right side. Abrasions were noted to the back of R1’s head, chin, right shoulder, and left foot. Bystanders contacted emergency services, and R1 was transported to the hospital for evaluation. Photographs taken at the hospital showed bruising to R1’s toes, lower extremities, right shoulder, both forearms, and the lower portion of the face near the chin. Hospital records further documented that R1’s family reported R1 had a history of hypertension, Parkinson’s disease, and confusion. R1 was diagnosed with altered mental status, abrasions, fall, syncope, and collapse.

Allegation: Resident wandered from the facility due to neglect/lack of supervision.
It is alleged that R1 walked out of the facility through the main gate.

Based on record review, hospital records dated March 4, 2025, revealed that Resident 1 (R1) was found injured by bystanders while wandering in the neighborhood. Hospital records further documented that R1 stated they climbed over the fence and exited the facility. A police report dated March 4, 2025, indicated that
Continued on LIC9099C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 22-AS-20250305152012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: COMFORT FIRST HOME CARE
FACILITY NUMBER: 306006547
VISIT DATE: 05/26/2026
NARRATIVE
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R1 was reported as a missing adult and had been missing since approximately 3:00 PM. Additional hospital records dated March 4, 2025, documented that R1 was diagnosed with altered mental status, abrasions, fall, syncope, and collapse. The records further indicated that R1 experienced hallucinations and had a family history of schizophrenia.

Based on interviews conducted, three out of three staff corroborated the allegation. S1 stated that R1 must have walked out of the facility and climbed over the fence because the gate was always locked. S2 stated that they were not at the facility at the time R1 was discovered missing; however, S2 was notified by S1 that R1 was no longer at the facility. S2 further stated that the facility was later informed by the hospital that R1 had been transported there. Staff 3 (S3) stated that they did not know much about the incident but were aware that R1 was not at the facility on the incident date.

Allegation: Facility is not maintaining resident's medication records.
It is alleged that facility did not have a copy of R1’s medication list when requested.

Based on interviews conducted, S1 and S2 stated that they did not have a medication log for R1. S1 and S2 indicated they believed a medication log was not necessary because R1 was able to manage their own medications.

Based on observations made on March 10, 2025, and March 18, 2025, LPA Kim did not observe an updated or current medication log for R1 at the facility.

Based on record review, the facility has a medication list for R1 from another facility dated October 22, 2024 and there were no prescriptions available for review. Based on information gathered, the facility did not maintain R1’s medication record.

Based on information gathered through interview and record review, the preponderance of evidence standard has been met, therefore, the allegations Resident sustained injuries due to neglect/lack of supervision, Resident wandered from the facility due to neglect/lack of supervision, and Facility is not maintaining resident's medication records were found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6 Chapter 8. An Immediate Civil Penalty is being assessed in the amount of $500. See the attached LIC421IM.
Continued on LIC9099C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 22-AS-20250305152012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: COMFORT FIRST HOME CARE
FACILITY NUMBER: 306006547
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/27/2026
Section Cited
CCR
87464(f)(1)
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87464(f)(1)Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
This requirement is not met as evidenced by:
Based on observation, interview, and record review, the licensee did not comply with the
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Licensee will provide training to all staff regarding proper care and supervision of all residents. Licensee stated they will send proof of all corrections to CCLD via email to edward.kim@dss.ca.gov by POC due date May 27, 2026.
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 section cited above. Facility staff did not provide appropriate care and supervision to R1 which resulted in R1 sustaining serious injuries while wandering around the neighborhood. This poses/posed an immediate health, safety or personal rights risk to persons in care.
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*Civil Penalty Assessed"
Type A
05/27/2026
Section Cited
CCR
87461(a)(1)
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87461 Mental Condition (a)The facility shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual: (1) tends to wander;
This requirement is not met as evidenced by:
Based on observation, interview, and
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Licensee stated they will assess all residents and create a plan of care and will send proof of correction to CCLD via email to Edward.kim@dss.ca.gov by POC due date May 27, 2026.
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 record review, the licensee did not comply with the section cited above. Facility staff did not provide appropriate care to monitor R1 which resulted in R1 wandering from the facility undetected This posed 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: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/05/2025 and conducted by Evaluator Edward Kim
COMPLAINT CONTROL NUMBER: 22-AS-20250305152012

FACILITY NAME:COMFORT FIRST HOME CAREFACILITY NUMBER:
306006547
ADMINISTRATOR:PHAM, MINHFACILITY TYPE:
740
ADDRESS:645 S MAGNOLIA AVETELEPHONE:
(714) 244-5687
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 4DATE:
05/26/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator- Jenny PhamTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff mismanaged resident's medication
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Administrator (ADMIN) Jenny Pham and explained the purpose of today’s visit.

The investigation consisted of the following: On March 10, 2025, LPA Kim conducted a health and safety visit with ADMIN Jenny Pham. LPA obtained copies of Rental/Lease Agreements and Hospital Discharge Records of the residents.

The investigation revealed the following:

Allegation: Staff mismanaged resident's medication

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 22-AS-20250305152012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: COMFORT FIRST HOME CARE
FACILITY NUMBER: 306006547
VISIT DATE: 05/26/2026
NARRATIVE
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It is alleged that R1’s medication had included a Vitamin B-12 that belonged to another resident. It is alleged that there is photo proof that the medication was placed in the wrong resident’s medication.

Based on observations made on March 18, 2025, Licensing Program Analyst Edward Kim observed medications stored on open shelves behind the staff desk in the office. The shelves were accessible, and the office door remained open and unlocked throughout the visit. On May 7, 2025, Investigator Ge Sun also observed a medication box on a shelf in the office and noted that the office door was open and unlocked.

R1’s medications were not observed during either visit because R1 did not return to the facility after being hospitalized. During the investigation, the Department reviewed a photograph showing R1’s medications on a couch alongside R2’s Vitamin B-12. However, there was no clear evidence that the medications were stored together improperly, as they may have been temporarily placed there during the sorting process.



Based on records review, interviews, and observations, LPA did not find sufficient evidence to support the above allegation Staff mismanaged resident's medication. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted and a copy of the report was provided to Administrator Jenny Pham.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 22-AS-20250305152012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: COMFORT FIRST HOME CARE
FACILITY NUMBER: 306006547
VISIT DATE: 05/26/2026
NARRATIVE
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A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49(f).

An exit interview was conducted, and a copy of this report and the appeal rights were provided to Administrator Jenny Pham.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 22-AS-20250305152012
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: COMFORT FIRST HOME CARE
FACILITY NUMBER: 306006547
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2026
Section Cited
CCR
87465(a)(6)
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87465 (a)A plan for incidental medical and dental care shall be developed by each facility... (6)When requested by the Department, a record... of ... medication shall be maintained by the facility.

This requirement is not met as evidenced by:
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Licensee stated they will ensure all medical records for all residents such as Medication Administration Record, Centrally Stored Medical Destruction Record, and other necessary documents. Licensee will train all staff and sent a copy of the training and all participants who attended with signature
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. Facility staff did not maintain the resident #1’s medication records as needed. This poses/posed a potential health, safety or personal rights risk to persons in care.
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to CCLD via email to edward.kim@dss.ca.gov by POC Due date June 5, 2026.
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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: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 8 of 8