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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881181
Report Date: 09/20/2024
Date Signed: 09/20/2024 11:29:21 AM

Document Has Been Signed on 09/20/2024 11:29 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:COUNTRY COMFORT #1FACILITY NUMBER:
331881181
ADMINISTRATOR/
DIRECTOR:		QUINLAN, GRACE DIANAFACILITY TYPE:
735
ADDRESS:49465 BLACK MOUNTAIN COURTTELEPHONE:
(951) 537-7509
CITY:AGUANGASTATE: CAZIP CODE:
92536
CAPACITY: 3CENSUS: 2DATE:
09/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Administrator, Grace Diana QuilanTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 9/20/2024, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Administrator, Grace Diana Quinlan. During the visit, there was one (1) client present and LPA was informed the other client was attending day program. The facility has a fire clearance for six (6) ambulatory clients and serves adults ages 18 through 59.

LPA toured the facility's interior and exterior with Administrator Quinlan. LPA observed client bedrooms had the required furniture and lighting. Bathrooms have a working toilet, wash basin, and were equipped with a grab bar in the shower. The facility has clean towels, blankets, and linen, available in different colors for the clients in care. A fence secured the entire backyard. Indoor and outdoor pathways were free of obstructions. No bodies of water were observed on the property. Outdoor shaded seating area is available for the clients in care. Medications are secured in a locked laundry room cabinet. Cleaning solutions are secured in a cabinet under the kitchen sink. Administrator Quinlan tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed a charged fire extinguisher mounted near the living room. Food is stored in a safe and healthful manner. LPA reviewed a client file and observed they had an updated Individual Program Plans and signed admission agreement. LPA was informed the facility conducts monthly emergency disaster drills. LPA reviewed the facility's emergency disaster training log and noted the facility's last fire drill was conducted on 09/05/24. Facility sketch, client's personal rights, and complaint information are visibly posted near the front entrance. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Quinlan.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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