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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004426
Report Date: 01/29/2025
Date Signed: 01/29/2025 11:03:10 AM

Document Has Been Signed on 01/29/2025 11:03 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:PRUDENT COMFORT HOMESFACILITY NUMBER:
306004426
ADMINISTRATOR/
DIRECTOR:		DORIS BELLFACILITY TYPE:
735
ADDRESS:1071-1073 E. 71ST STREETTELEPHONE:
(562) 470-7018
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 6CENSUS: 4DATE:
01/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Wykelia BradyTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On 01/29/25, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Wykelia Brady as the purpose of the visit was explained. The facility is licensed to serve six (6) ambulatory brain injured/mentally disabled adults with restricted health conditions ages 18-59. The current census for the clients is (4), only (1) client is linked to the Harbor Regional Center. Annual fees are current.

The facility is a 2 single-story buildings, on the same lot, The first building (1071) consists of 3 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and attached garage that is used as a staff office/ storage. The second building (1073) consists of 2 Client bedrooms, 1 Live-in Staff bedroom, 2 bathrooms, living room, dining room, kitchen, and attached garage used as storage unit. Client bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to clients. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to clients, no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards.

LPA conducted a records review of 3 staff records, 4 client records, 4 medication administration records. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 12/29/24, 1 fire extinguisher fully charged and located in the kitchen in both units, carbon monoxide and smoke detectors are operational in both units, land line and internet service were observed.

Exit interview conducted, appeal rights explained, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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Document Has Been Signed on 01/29/2025 11:03 AM - It Cannot Be Edited


Created By: Lizeth Villegas On 01/29/2025 at 10:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: PRUDENT COMFORT HOMES
FACILITY NUMBER: 306004426

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80022(a)
80022 Plan of operation
Each licensee shall have and maintain on file a current, written, definitive plan of operation.

Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as the facilty is using a MAR however, the MAR for Client # 3 is not properly documented as medication is being passed but not documented which poses/posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 02/12/2025
Plan of Correction
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Licensee to conducted an in-service on medication pass procedures and medication documentation. Licensee to provide LPA with documentation of training including topis, and, names and signatures on staff who attended the in-service. Proof to be sent to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2025


LIC809 (FAS) - (06/04)
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