<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202955
Report Date: 11/08/2024
Date Signed: 11/08/2024 11:49:57 AM

Document Has Been Signed on 11/08/2024 11:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:COMFORT HOMESFACILITY NUMBER:
435202955
ADMINISTRATOR/
DIRECTOR:		TRAN, KEVIN; BUI, TUYENFACILITY TYPE:
735
ADDRESS:3346 PRADO LNTELEPHONE:
(408) 667-8440
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 0DATE:
11/08/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Kevin Tran, Tuyen BuiTIME VISIT/
INSPECTION COMPLETED:
11:48 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Marcela Yanez, Kenneth Madrigal, and LPM Romeo Manzano arrived announced to conduct the pre-licensing inspection. LPAs and LPM met with Applicants Kevin Tran and Tuyen Bui.(Board Members of Little Smiles Inc). The facility fire clearance is approved for 6 Non-Ambulatory residents.

LPAs and LPM toured the facility inside and out. There are 4 resident's bedrooms. Bedrooms equipped with beds, linens and adequate lighting, furniture such as bed, dresser and chair and closet space for residents. Applicant stated there is no staff bedroom. Applicants stated they will have 3 shift 7am-3pm, 3pm-11pm and 11pm to 7am.

There are 3 fire extinguisher in the facility (1 across the medication room/closet; 1 across the main bathroom on the wall across the bathroom #1) purchased on 05/05/2024. The facility has medication room/closet wherein they have residents' individual boxes for their medication and also this is where they will store or kept residents P and I and residents files. The facility had a First Aid kit that was complete with tweezers and gauze and scissors.
The facility was equipped with emergency lighting and night light inside and out.

The kitchen area was toured. Kitchen utensils observed such as but not limited to cups, plates. KItchen appliances were observed with microwave and a refrigerator. The refrigerator temperature maintained at 37 degrees Fahrenheit. Freezer temperature maintained at 0 degrees Fahrenheit. The knives and sharp objects were kept underneath the kitchen sink cabinet equipped with a magnetic key and were observed in bathroom cabinets for hygiene kits.
The facility had a working land line. The facility has a power generator and window screens in all sliding doors and windows,
Page 1 of 2
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: COMFORT HOMES
FACILITY NUMBER: 435202955
VISIT DATE: 11/08/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2 of 2

The facility had washer and dryer. The laundry area was observed with a locked key pad where the toxics and cleaning supplies are kept.

The water temperature range for facility bathroom #1 121.1 degrees, bathroom #2 118.4 degrees F and bathroom #3 119.4 degrees F. The water temperature in the kitchen was measured at 118.5 degrees F.
The facility had washer and dryer. The laundry area was observed with a locked key pad where the toxic and cleaning supplies are kept.

The backyard was inspected. There are 3 designated ramps one from the main door with hand rails and exit from patio door and bedroom #2 were observed with hand rail as well and exits were free and clear of obstruction. During tour 2 locked sheds were observed and used for storage and not for living space.

During inspection for bedroom #4 there are 2 exit doors one going to the backyard exit facing the house, and one exiting to the driveway. The doors knobs were replaced with single action mechanism also LPAs suggested if applicant can purchase a stove knob cover.

Component III orientation was completed with applicants.

No issues noted during this pre-licensing inspection. LPAs observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

This report was reviewed with Applicants Kevin Tran and Tuyen Bui and a copy of the report was provided. .
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2