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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881360
Report Date: 09/06/2022
Date Signed: 09/06/2022 02:12:17 PM

Document Has Been Signed on 09/06/2022 02:12 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:COMFORTING ARMS ARFFACILITY NUMBER:
331881360
ADMINISTRATOR:SIMMONS, ALEXFACILITY TYPE:
735
ADDRESS:1361 HAVEN PLACETELEPHONE:
(951) 323-5427
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY: 4CENSUS: 0DATE:
09/06/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Alex Simmons - ApplicantTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility for the purpose of conducting a Pre-Licensing visit. Analyst met with Applicant Alex Simmons, who LPA Colvin informed of the purpose of today's visit, and toured the facility with the applicant. Of note, the applicant currently has a licensed facility (#331880955) which is undergoing a change of location to this address.

Fire Clearance was granted for four (4) ambulatory residents on 8/3/22 by the Hemet Fire Department. The facility is going to apply to be vendorized through Inland Regional Center for developmentally disabled adults ages 18 - 59 once licensed. Home is set-up with living room, family room, kitchen, dining room, four (4) resident bedrooms,4 restrooms, office, backyard, laundry room, and a garage.

LPA Colvin observed required accommodations in residents' bedroom and bathrooms, apart from essential furniture (beds, mattresses, etc.) which remain at the currently licensed location (#331880955) along with the residents. LPA Colvin observed towels and linen stocked in the cabinets at the facility along with some items such as new pillows and rugs in resident bedrooms. Smoke detectors and carbon monoxide units are all operable, as observed by LPA Colvin when applicant tested them. Common areas such as dining and living rooms were observed to be clean and in good condition.

ADMINISTRATION/MEDICATION: Files and medication will be locked in closet centrally located near the kitchen.

PHYSICAL PLANT: Outside premises were inspected for potential hazards. Cleaning solutions and other hazardous items are stored and locked in additional closet or garage. Outside gate was observed to be unlocked for clients' and staff's use in case of emergency as an exit. Exit route from backyard was observed to be free of obstruction. LPA Colvin tested the facility's hot water and observed it to be measuring at 115.7 degrees.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: COMFORTING ARMS ARF
FACILITY NUMBER: 331881360
VISIT DATE: 09/06/2022
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ACTIVITIES: Inside and outside, there are areas for residents to use for their leisure. Backyard is in good condition with outdoor furniture (to be brought with other essential furniture from other licensed location) and a shaded area for the residents. Facility additionally has magazines, tv, books, and games for resident's use.

FOOD SERVICE: The kitchen area was observed for the ability to serve food and cleanliness. Trash can has tight-fitting lid. Dishes, utensils and glasses are present and in sufficient number for residents and staff, though applicant notes that more will be coming to the facility along with the residents. Dishwasher will be used to clean and sanitize dishes. Knives will be kept locked and out of clients' reach for safety purposes, as well as cleaning chemicals. All need appliances were present and shown to be in working condition and clean. Facility has both perishable and non-perishable supply of food to satisfy the 2 day and 7 day requirements and emergency supplies were observed in the closet.

EMERGENCY EXIT PLAN: Facility has an emergency exit plan in place an posted in plain view at the facility, along with operational smoke detectors and carbon monoxide detectors, and fire extinguishers. Applicant has completed and submitted a Mitigation Plan for Infection Control for the facility as well. LPA Colvin observed a 30-day supply of PPE (isolation gowns, gloves, masks) in the closet and applicant informed LPA Colvin that they will be bringing more from the current facility.

Analyst will inform Centralized Applications Bureau (CAB) about the Pre-Licensing visit and Applicant will be notified of the license approval.

An exit interview was conducted with Applicant Alex Simmons and a copy of the report was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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