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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701472
Report Date: 03/10/2025
Date Signed: 03/10/2025 02:36:52 PM

Document Has Been Signed on 03/10/2025 02:36 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HLZ COMFORT CARE CORPORATIONFACILITY NUMBER:
342701472
ADMINISTRATOR/
DIRECTOR:		LE, HUGHFACILITY TYPE:
735
ADDRESS:8617 LODESTONE CIRCLETELEPHONE:
(916) 390-4850
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 0DATE:
03/10/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Hugh LeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analysts (LPA) Victoria Brown and Sommer Hayes arrived announced to conduct a Pre-Licensing Inspection on 3/10/2025 at 11:00am. LPAs were allowed entry into the home that will be licensed for a capacity of 4 ambulatory residents and 1 non-ambulatory. LPA met with Hugh Le, Applicant who assisted with todays visit. Administrator certificate expires 12/5/25.

LPAs and Hugh Le toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed there are no residents at this time.

LPAs observed the kitchen area, dining area, bedrooms, bathroom, storage areas, and laundry rooms. LPAs observed knives/sharps area to be locked. LPA observed required furniture, and lighting throughout the facility. The hot water temperature was measured at 119.5*F is within the required range of 105-120*F. The temperature inside the facility measured at 72*F which is within the required range of 68-85*F.
LPAs observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days 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. LPA observed centrally stored medications area to be locked. LPA observed the fire extinguisher(s), smoke and carbon monoxide detector(s) in the home. Facility has central heating and air.
LPA observed the area where the staff and resident files will be locked and readily available for review.

Component III conducted - Licensure pending.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no violations cited during this visit. Exit interview held, copy of report given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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