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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881250
Report Date: 02/09/2022
Date Signed: 02/09/2022 01:07:12 PM

Document Has Been Signed on 02/09/2022 01:07 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HOME OF COMFORT LLCFACILITY NUMBER:
331881250
ADMINISTRATOR:HAWKINS, TASHAFACILITY TYPE:
735
ADDRESS:26545 ROLAND ROADTELEPHONE:
(951) 987-6069
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 4CENSUS: 0DATE:
02/09/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:ADMINISTRATOR TASHA HAWKINSTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Venus Mixson met with administrator Tasha Hawkins for Pre-Licensing at 26545 Roland Rd. Murrieta CA. 92563. An application to license an Adult Residential Facility (ARF) was received by Centralized Applications Bureau (CAB) on Oct. 12, 2021, for a total four ambulatory beds. Fire Inspection was granted Nov.5, 2021, by Murrieta Fire & Rescue. LPA Mixson observed the following:
Structure: Was a single-story home with four bedrooms, two bathrooms, living /dining areas, spacious kitchen, and laundry area.
Heating/Cooling System: Central heating and air conditioning systems.
Bedrooms: Four (4) ambulatory residents. Bedrooms were adequately furnished with bed, appropriate linen, adequate lighting, and smoke detectors.
Bathrooms: Have a working toilet, wash basin, and shower with an adequate supply of towels, toilet paper, and toiletries. Water temperature measured between 105 & 110 F.
Kitchen/Laundry: Was adequately supplied with dishes, glasses, utensils, pots, and pans were observed. Cleaning supplies and knives/sharp instruments were secured and locked separately. There was adequate room for food storage. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. Seating for meals was adequate.
Living/Family room(s): Has adequate seating and furnishings items appear to be in good repair.
Hygiene Supplies/Linens: Were adequate in supply, and there were enough linens to change throughout the week if needed.
Outside/Yards: No obstructions or bodies of water observed on the property.









SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HOME OF COMFORT LLC
FACILITY NUMBER: 331881250
VISIT DATE: 02/09/2022
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Laundry/Garage: The laundry room was near the garage with washer and

dryer. Laundry detergents and cleaning solutions were secured in a locked

cabinet. Garage was organized and free of obstructions.

Exit Plan/Emergency Phone Numbers: The exit plan was in plain sight

close to front door. See Something Say Something and client’s rights are

posted.

General items: Facility has five (5) smoke alarms and carbon monoxide

detectors. These were tested and operational.

LPA Venus Mixson observed facility phone and it was verified to be

operational by allowing the administrator to call the number (951) 249-9793.

LPA Venus Mixson reviewed COMPONENT III with applicant during

Pre-Licensing visit.

An exit interview was conducted. A copy of this report was reviewed,

signed, and a printed. A copy of report was left with the administrator Tasha

Hawkins.

The Pre-Licensing visit is completed there are no deficiencies.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC809 (FAS) - (06/04)
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