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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700961
Report Date: 02/15/2022
Date Signed: 02/23/2022 04:20:58 PM


Document Has Been Signed on 02/23/2022 04:20 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, 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: 6DATE:
02/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jacqueline ChanTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA) Victoria Brown and Jamie Ivey Canady arrived unannounced to conduct a Required - 1 Year visit on 2/15/22 at 11:30am. LPA was allowed entry into the home that is licensed for a capacity of 6.

LPA met with Karen Quidilig, Caregiver and Jacqueline Chan, Administrator and stated the purpose of todays visit.

Administrator certificate expires 9/2/22.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2 day perishables and 7 day non-perishables.

The temperature inside the facility measured at 70*F which is within the required range of 68-85*F. The hot water temperature was measured at 115.8*F which is within the required range of 105-120*F.

LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility.

LPA observed the centrally stored medications area to be locked and inaccessible to residents.

The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. Exit interview held, copy of report given.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria BrownTELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2022
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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