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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004426
Report Date: 01/26/2022
Date Signed: 01/26/2022 03:06:50 PM

Document Has Been Signed on 01/26/2022 03:06 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:PRUDENT COMFORT HOMESFACILITY NUMBER:
306004426
ADMINISTRATOR:DORIS BELLFACILITY TYPE:
735
ADDRESS:1071-1073 E. 71ST STREETTELEPHONE:
(562) 470-7018
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 6CENSUS: 5DATE:
01/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Tina BellTIME COMPLETED:
03:15 PM
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On 01/26/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced annual inspection
with emphasis on infection control. LPA was met by Direct Support Staff Tina Bell, and the purpose of
the visit was explained.

LPA and Staff toured the facility which has 2 single-story buildings, on the same lot, with address numbers 1071-1073 The first building (1071) consists of 3 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and attached garage. The second building (1073) consists of 2 Client bedrooms, 1 Live-in Staff bedroom, 2 bathrooms, living room, dining room, kitchen, and attached garage.

All outdoor and indoor passageways were free of obstruction. Each client's room has clean linens, a lamp, a chest of drawers, and closet space. The bathrooms were clean and free of mold/mildew. Client rooms are equipped with a wired smoke detector and is operational. There is one working carbon monoxide detector in the living room for each building.

LPA observed a minimum of two days perishable and a week of nonperishable foods maintained at the facility.

LPA reviewed 4 Client files, and 4 Staff files, and 1 Medication Record. The client files reviewed have the following documentation: Admission Agreement, Identification and Emergency Information, Consent forms, Physician's Report that includes the T.B. test results. Their Needs and Services Plans are updated as necessary. All medications were up to date, and were centrally stored and locked, making it inaccessible to clients.

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: PRUDENT COMFORT HOMES
FACILITY NUMBER: 306004426
VISIT DATE: 01/26/2022
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LPA observed a minimum of 30 day PPE Supplies were observed. Required positings of hand hygeine, were posted through out the facility. LPA observed a visitor and staff log book, with covid 19 questions, and screenings. Record review of staff files showed that staff have had their N95 fit testing, and are in compliance with Cal Osha Regulation. Lpa observed designated room and bathroom for isolation if a resident were to contract Covid-19. Staff have been made aware of sick leave policies regarding Covid-19, and are following their mitigation plan.

An Exit interview was conducted, and a copy of this report was provided. No citations were issued
during this visit.
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: PRUDENT COMFORT HOMES
FACILITY NUMBER: 306004426
VISIT DATE: 01/26/2022
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11-AS-JJON-CB2RYR-20220126122622735 ARF Tool 12272021.pdf11-AS-JJON-CB2RYR-20220126122622735 ARF Tool 12272021.pdf
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3