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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200184
Report Date: 02/24/2023
Date Signed: 02/24/2023 01:47:16 PM

Document Has Been Signed on 02/24/2023 01:47 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
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:COMFORT CARE HOME, LLCFACILITY NUMBER:
079200184
ADMINISTRATOR:REY & MARY JANE VELASQUEZFACILITY TYPE:
735
ADDRESS:1788 ELMHURST LANETELEPHONE:
(925) 691-9743
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 6CENSUS: 4DATE:
02/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Leonora Maneja, AdministratorTIME COMPLETED:
02:00 PM
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On 2/24/2023 at 12:50 PM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct an annual Infection Control Inspection. LPA met with Administrator, Leonora Maneja and explained the purpose of the visit.

During the Infection Control Inspection, LPA toured facility with Leonora including but not limited to front entrance, hand washing stations, bedrooms, common areas, kitchen, and backyard. Facility has a sufficient 2 day perishable and 7 day nonperishable food supply. There is one central entry point for universal screening for staff, residents, and visitors. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily.
Bathrooms are equipped with liquid soap, paper towel and trash bins with touchless lids. Facility has a 30 day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan. Smoke and carbon monoxide detectors were observed and maintained. First Aid kit was complete. Fire extinguisher was observed and is scheduled to be serviced on Monday 2/27/2023. LPA observed facility passages inside and out free of obstruction.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Paris Watson
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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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