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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700961
Report Date: 03/03/2021
Date Signed: 03/03/2021 04:09:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:COMFORTS OF HOME TREASUREFACILITY NUMBER:
342700961
ADMINISTRATOR:KANG, MARIAFACILITY TYPE:
740
ADDRESS:6997 TREASURE WAYTELEPHONE:
(916) 833-1493
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:6CENSUS: 0DATE:
03/03/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Maria KangTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (s) (LPA) Victoria Brown and Tirzah Hubbard contacted the facility via telephone to commence an announced Tele-visit via Facetime on 3/3/2021 at 3:00pm due to COVID-19 and pre-cautionary measures. The team met with Maria Kang, Applicant to conduct a Pre-Licensing Inspection and discussed the purpose of the call and the elements of this type of visit.
The team were allowed entry into the home that will be licensed for a capacity of 6 non-ambulatory residents. Administrator certificate expires 9/2/2022.
The team toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. The team observed there are no residents at this time.
The team observed the kitchen area, dining area, bedrooms, bathrooms, storage areas, and laundry area. The team observed knives/sharps area to be locked. The team observed required furniture, and lighting throughout the facility. The hot water temperature was measured at 119.0*F is within the required range of 105-120*F. The temperature inside the facility measured at 69*F which is within the required range of 68-85*F.
LPA observed area where food supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days will be maintained on the premises.
The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. The team observed centrally stored medications area to be locked. The team observed the fire extinguisher(s), smoke and carbon monoxide detector(s) in the home. Facility has central heating and air. The team observed the area where the staff and resident files will be locked and readily available for review. The Mitigation Plan shall be submitted within 2 days.

Component III conducted - Licensure pending.
Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. An exit interview was conducted with Maria Kang via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021
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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