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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003651
Report Date: 07/27/2023
Date Signed: 07/27/2023 04:29:09 PM


Document Has Been Signed on 07/27/2023 04:29 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 COTTAGES #1FACILITY NUMBER:
306003651
ADMINISTRATOR:FAROOQ RASHIDFACILITY TYPE:
740
ADDRESS:25231 MACKENZIETELEPHONE:
(949) 584-7083
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 4DATE:
07/27/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Farooq Rashid, AdministratorTIME COMPLETED:
05:00 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to follow up on the plan of corrections established regarding deficiencies observed during the initial investigation visit held on June 2, 2023 for complaint referenced 22-AS-20230526155220. At the time of the present visit, there are two residents indicated as bedbound per their medical assessments.

The Fire Marshall from the Orange County Fire Authority made a visit to the facility and prescribed the installation of sprinklers in order for the fire clearance to include up to six bedbound. The house is stated to have been confirmed to already meet clearance criteria for two bedbound residents, however facility administrator decided to go ahead with an upgrade of fire safety systems and the installation of sprinklers. The contractor selected to perform the installation has submitted all necessary paperwork to the Orange County Fire Authority for final approval. Preliminary steps to allow the installation were confirmed to have been completed as LPA toured the physical plant with administrator Farooq Rashid.

After approval of the installation, there will be a final inspection by the Fire Marshall which will be accompanied by an update of the present fire clearance to include a maximum of six bedbound residents. Each of the four bedrooms occupied by residents is confirmed to be equipped with double wide doors to the exterior of the facility allowing for emergency exits with the hospital beds observed to be in place. Photographs of the doors were taken by LPA and added to the facility file.

The cited deficiency will be cleared by LPA after final confirmation of an approved fire clearance is provided.

At this time, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to facility administrator.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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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