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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881130
Report Date: 09/15/2023
Date Signed: 09/15/2023 02:57:44 PM

Document Has Been Signed on 09/15/2023 02:57 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:C & M COMFORT HOMEFACILITY NUMBER:
331881130
ADMINISTRATOR:COURT, CHRISTIANFACILITY TYPE:
735
ADDRESS:24662 MANTEE PLACETELEPHONE:
(951) 378-5820
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 6CENSUS: 5DATE:
09/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee Christian CourtTIME COMPLETED:
03:10 PM
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On 9/15/2023, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for an annual inspection. LPA met with Licensee Christian Court.

LPA conducted a tour of the facility's interior and exterior with Licensee Court. The facility is made up of four (4) client bedrooms, two (2) client bathrooms, a kitchen, dining room, living room, staff room and garage. The facility is approved to care for four (4) ambulatory and two (2) non-ambulatory clients and serves adults ages 18 through 59. During the visit, there was one (1) client and three (3) staff present, and LPA was informed that four (4) clients were out in the community.

During the tour, LPA observed the following:

The facility has two (2) fire extinguishers that were charged on August 4, 2023. LPA tested the smoke and carbon monoxide detectors and found them to be operational. The facility does not have bodies of water. Outdoor and indoor passageways were kept free of obstruction. The outside of the facility had a shaded area with seating. Cleaning solutions, knives, and client and staff files were secured in file cabinets stored in the staff room. LPA observed that centrally stored medications were also stored in a separate file cabinet in the staff room. LPA reviewed physical medications for two (2) clients along with the Medication Administration Record (MAR) used to log administration of clients' medications. LPA did not discover any discrepancies. The facility had a complete first aid kit.

Continued on LIC809-C..

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: C & M COMFORT HOME
FACILITY NUMBER: 331881130
VISIT DATE: 09/15/2023
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Continued from LIC809..

LPA toured the kitchen. Food was stored in a safe and healthful manner. The facility had a menu available for review. LPA observed that the facility had a more than a two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. Home temperature was comfortably set to 76-degrees Fahrenheit. Client bedrooms had the required furniture and functional lighting. LPA toured the bathrooms and observed grab bars and nonskid mats in the shower. The hot water temperature in client bathrooms measured at 105-degrees Fahrenheit. The facility had additional linen and towels stored in a hallway closet. LPA toured the garage and observed emergency supplies, water, and two additional refrigerators with food. During LPA's visit, staff was doing laundry and LPA observed that washer and dryer were operable and stored in the garage. Staff present have a criminal background clearance on file, proper association to the facility, and current CPR/First Aid certification. The facility's last earthquake was held on 6/21/2023 and fire drill on 7/27/2023. The facility does not handle clients' cash resources.

During today's visit, LPA did not observe any deficiencies. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Court.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023
LIC809 (FAS) - (06/04)
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