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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606703
Report Date: 07/23/2024
Date Signed: 07/23/2024 12:42:30 PM


Document Has Been Signed on 07/23/2024 12:42 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:COMFORT AND CARE FOR THE ELDERLYFACILITY NUMBER:
300606703
ADMINISTRATOR:LAYTON, PILARFACILITY TYPE:
740
ADDRESS:24052 CARRILLO DRIVETELEPHONE:
(949) 690-4631
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
07/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Pilar Layton- AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual inspection using the CARE Inspection Tool. LPA met with Administrator Pilar Layton and explained the reason for the visit.

The facility is a two level structure located in a residential neighborhood. The upper level is a private unit with a separate access door. Facility is licensed to operate for six (6) non-ambulatory residents and maintains a hospice waiver for four (4). There are six residents in care with one in hospice and two caregivers on duty during today's visit.

LPA observed the facility to be clean and sanitary. There are four resident bedrooms and two resident bathrooms. All common areas were inspected including the attached two car garage and the sitting room which is utilized as a staff bedroom. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The water temperature measured at 112.7 and 114.9 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway free of obstructions. The exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. Facility maintains a fire extinguisher that was mounted, charged, and serviced on September 14, 2023. The auditory devices and smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency disaster supplies including food/water in the garage. Facility is conducting emergency drills however is not maintaining a log. Administrator was advised to maintain a log. The first aid kit contains all required elements.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/23/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: COMFORT AND CARE FOR THE ELDERLY
FACILITY NUMBER: 300606703
VISIT DATE: 07/23/2024
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LPA observed the required 'See Something, Say Something' (PUB475) poster in 8.5"x11" posted in the hallway. Administrator was reminded to post the PUB475 in the size of 20"x26" in the entry way as required per regulation. The Administrator's Certificate for Pilar Layton expires on December 23, 2024.

LPA conducted an audit of six residents' files and two personnel files. No discrepancies were noted. Staff and one resident interview were conducted as the remaining residents were either occupied or sleeping. Medications were audited for six residents. No discrepancies noted.

Based on the observations made during today's visit, no deficiency is being cited today. Advisory Notes were issued. An exit interview was conducted with Administrator Pilar Layton, and a copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC809 (FAS) - (06/04)
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