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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700654
Report Date: 09/14/2023
Date Signed: 09/14/2023 03:47:06 PM

Document Has Been Signed on 09/14/2023 03:47 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:KANNO'S COMFORT CARE 2FACILITY NUMBER:
502700654
ADMINISTRATOR:KANNO, JANETFACILITY TYPE:
735
ADDRESS:1113 GRAND PRIX DRTELEPHONE:
(209) 532-2260
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 4CENSUS: 4DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Saul KannoTIME COMPLETED:
03:30 PM
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On 09/14/2023, Licensing Program Analyst, (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct an annual inspection. LPA identified herself, the reason for the visit and asked to speak to the Designated Facility Administrator. LPA met with Saul Kanno, the Licensee/Administrator and a brief interview followed.

The tour began in the kitchen. All sharps were locked in a drawer and inaccessible to residents in care. LPA inspected all cabinets and drawers. LPA observed a food supply of 7 days of non-perishable and 2 days of perishable. LPA inspected the refrigerator and freezer to ensure all foods were appropriately packaged and dated.

The facility license, emergency plan, and LIC 500 were all posted and available to Licensing. The fire extinguisher was last inspected on 09/6/2023 by Jorgensen Co.

The LPA inspected the 3 bedrooms and found all to have the required furniture, furnishings, and lighting to be in compliance.

LPA inspected the 2 bathrooms and found an adequate supply of soap and paper towels. LPA measured the hot water to ensure it fell between 105 and 120 degrees Fahrenheit.

The LPA then inspected the exterior of the building. There were no bodies of water or outbuildings present. There was a shaded outdoor area with seating in both the front and rear of the building for residents to enjoy. LPA observed an ill-fitting screen over an air conditioner, and a headboard and footboard for a twin size bed on the side of the house. Licensee/Administrator stated that the headboard and footboard were scheduled to be disposed of next week and that the air conditioner would be taken down next week as well.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: KANNO'S COMFORT CARE 2
FACILITY NUMBER: 502700654
VISIT DATE: 09/14/2023
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All medications were secured in a locked closet adjacent to the kitchen and inaccessible to residents in care. LPA inspected medications, CSMR, and reviewed dosing, storage and destruction procedures. The first aid kit was also inspected and found to be complete.

This facility also handles residents' cash. LPA reviewed the ledgers to ensure funds were accounted for.

A review of 3 staff files and 2 resident files was conducted. All staff files were in compliance and all staff were First Aid/CPR certified. Resident files were also in compliance.

There were no deficiencies observed or cited during today's visit.

A copy of this report was provided.

Exit interview.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
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