197610213-12-4-2024-31-AS-LCAS-DBMSDM-20241204124723

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610213
Report Date: 12/04/2024
Date Signed: 12/04/2024 12:48:58 PM

Document Has Been Signed on 12/04/2024 12:48 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNRISE COMFORT		FACILITY NUMBER:	197610213
ADMINISTRATOR/ DIRECTOR:	OCHOA, MIRANDA		FACILITY TYPE:	735
ADDRESS:	45568 RODIN AVE		TELEPHONE:	(310) 920-4666
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 4		CENSUS: 3	DATE:	12/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Miranda Ochoa		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

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At 9:00 am Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced annual visit and was greeted by the Administrator, Miranda Ochoa. The facility is licensed as an adult residential facility to serve four (4) ambulatory clients. The facility is now vendorized and approved for a Level 4G through North Los Angeles Regional Center and currently has three (3) clients in care. All clients are currently out in the community and at day program.

LPA and the Administrator began the tour of the facility at 10:20 a.m. LPA observed the following:

Upon entry LPA observed required posting along the walls of the facility.

Infection control: LPA reviewed mitigation plan approved on 11/17/2021 to make sure the licensee was following current infection control recommendations.

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

Bathroom: There are two (2) client bathrooms one (1) is 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. Sharps and medications are also locked and stored in the locked hallway closet.

Common Areas: These include the living area and dining area. LPA observed dining and living room furniture in good repair. Dining 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 07/16/2024. The facility is kept at a comfortable 72 degrees F.

Continued on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SUNRISE COMFORT	FACILITY NUMBER: 197610213
	VISIT DATE: 12/04/2024

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Kitchen: LPA observed a seven (7) day supply of non-perishable foods and a two (2) day supply of perishable foods that were properly stored. LPA observed kitchen are to be clean and free of clutter.

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

Garage: The garage has its 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 10:50 am and were observed operational.

Staff and Client Files: At 11:30 am LPA reviewed staff and client files. All files are within regulation.

Medication: At 12:15 pm LPA and Administrator reviewed medication and medication logs.

Staff and Client Interviews: At 12:25 LPA only conducted a staff interview as the clients were not at home.

No citations issued. Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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