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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609626
Report Date: 01/21/2025
Date Signed: 01/21/2025 10:44:32 AM

Document Has Been Signed on 01/21/2025 10:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:COMFORT HOME #1FACILITY NUMBER:
197609626
ADMINISTRATOR/
DIRECTOR:		KANGALA, EMMANUELFACILITY TYPE:
735
ADDRESS:10156 COLLETT AVETELEPHONE:
(310) 709-8299
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 4DATE:
01/21/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:32 AM
MET WITH:Kulwant Kaur- AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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At 9:34AM on 1.21.2025, Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced case management visit. At 10AM LPA met with the Administrator Kulwant Kaur and disclosed the reason for the visit.

Today’s case management visit is to follow up on a series of unusual incidents previously reported on 4.8.2024 to 1.2.2025 by the facility in which Clients #1 (C1) is continuously attacking clients as well as facility staff. The purpose of the visit is to obtain additional information regarding these incidents.

LPA interviewed Administrator, staff #1 (S1) at 10:25AM. LPA staff at 10:15AM.

On 1.1.2025 C1 had a behavior episode where C1 continuously physically attacked staff to the point that staff was not successful in redirecting C1, therefore staff called 911 for 5150. The behavior from C1 has continued on a daily basis and redirection is not always successful. Staff has had the need to call 911 to get assistance with C1’s escalating behavior. Facility is working with behavioral staff, NLARC and C1's family that it is best for C1 to go home with the family instead of relocating to another facility. Facility has sent appropriate special incident reports to Community Care Licensing, behaviorist, and North Los Angeles Regional Center.

Since the Administrator has taken the appropriate actions to ensure staff are appropriately caring for C1 and that protocols are being followed for C1’s behaviors, there are no deficiencies cited at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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