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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610213
Report Date: 12/05/2023
Date Signed: 12/05/2023 10:53:01 AM

Document Has Been Signed on 12/05/2023 10:53 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNRISE COMFORTFACILITY NUMBER:
197610213
ADMINISTRATOR:OCHOA, MIRANDAFACILITY TYPE:
735
ADDRESS:45568 RODIN AVETELEPHONE:
(310) 920-4666
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
12/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Miranda OchoaTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual visit and was greeted by the Administrator. The facility is licensed as an adult residential facility to serve four ambulatory clients. The Administrator confirmed there are no clients living in the facility and they are waiting for clients from the North Los Angeles County Regional Center (NLACRC). Administrator stated they are now vendor through NLACRC and are awaiting for a liaison.

LPA and the administrator began the tour of the facility at 9:30 a.m. LPA observed the following:
Upon entry LPA observed required posting along a wall of the facility.

Bedrooms: There are four (4) client bedrooms for single use. LPA observed bedrooms to be properly furnished with a bed, linens, night stand, chair, chest of drawers, closet, and adequate lighting.

Bathroom: There are two (2) client bathrooms one (1) is located in a client's bedroom for private use. The bathrooms contained hand soap, paper towels, toilet paper and trash bins.

Hallway Closets: LPA observed two (2) closets locked that contained a first aid kit, PPE supplies, toiletries, and cleaning chemicals. According to the administrator this is were the medications and facility records will be stored.

Common Areas: These include the living area and dining area. LPA observed dining and living room furniture in good repair. Dinning and living room furniture sits the capacity of the facility. The fire extinguisher is located in the living area and was observed fully charged with a serviced date of 04/28/2023.

Kitchen: LPA observed a seven day supply of non-perishable food and a two day supply of perishable foods; properly stored. LPA observed a locked toolbox where sharps are stored.

(Cont'd on LIC809-C)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SUNRISE COMFORT
FACILITY NUMBER: 197610213
VISIT DATE: 12/05/2023
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(Cont'd from LIC809)

Laundry Room: LPA observed the laundry room is accessible and contains a washer and dryer. Detergents will be locked in a hallway closet.

Garage: The garage has it's own entrance on the outside of the facility. LPA observed emergency supplies, and additional storage for the facility.

Backyard: LPA observed a patio area with shade for clients. LPA observed appropriate outdoor furniture for client use. The side gate leading from the backyard to the front yard was not locked.

Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested at 10:20 a.m. and were observed operational.

There were no deficiencies observed at this time. Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC809 (FAS) - (06/04)
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