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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881250
Report Date: 04/25/2023
Date Signed: 04/25/2023 12:00:41 PM

Document Has Been Signed on 04/25/2023 12:00 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:VANESSA TAYLORFACILITY TYPE:
735
ADDRESS:26545 ROLAND ROADTELEPHONE:
(951) 987-6069
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 4CENSUS: 0DATE:
04/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:ADMINISTRATOR, VANESSA TAYLORTIME COMPLETED:
12:15 PM
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On April 25, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with Administrator, introduced self, and stated the purpose of the visit.
LPA Mixson toured the facility, along with the Administrator, and inspected the inside and outside of the facility. The facility is a single story home, and currently there are no residents residing in the home. There are four staff associated to the facility, and no residents currently residing in facility. Currently only the Administrator is present. The facility has four bedrooms and two full baths. There a single kitchen, dining room, and living room. Additionally, the facility has a two car garage and a back yard.
Physical Plant: The physical plant, is in good condition, neat, and orderly. The lawns and shrubbery are well maintained. Outdoor and indoor passageways are free of obstruction at the time of this visit. Residents bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. The bedroom temperatures were comfortable although there were no residents residing in the home. All resident bedrooms were equipped with the required items. The Administrator tested the hot water temperature in the restroom, in which the bathroom sink faucet tested within the required regulation. The restrooms were equipped with non-skid surfaces and grab bars. LPA Mixson toured the kitchen and dining area. The facility had a menu posted and available for review. Kitchenware was in good condition and stored safely. Emergency food and water were observed.
Continued on the next page- LIC809-C.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HOME OF COMFORT LLC
FACILITY NUMBER: 331881250
VISIT DATE: 04/25/2023
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Required annual continued from LIC 809, on 04/25/2023.

LPA Mixson inspected the common areas. Smoke detectors are hard wired and were tested.

The fire extinguisher was in the green and had not been used. Carbon monoxide alarms, along with smoke detectors were observed, and showed a green light. Fireplace has screen, is covered, and locked.

There was a locked and centralized storage area for medications. Medications will be ordered through a pharmacy that utilizes bubble packs. The facility had a designated area for resident and staff files, and it was lockable. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for activities. LPA Mixson observed a monthly activity calendar.

LPA Mixson reviewed four staff files, zero resident files, and conducted one interview the Administrator.

There were no regulation violations observed during todays visit.

An exit interview was conducted and a copy of this report was provided to Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC809 (FAS) - (06/04)
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