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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701015
Report Date: 07/15/2024
Date Signed: 07/16/2024 09:09:54 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/16/2024 09:09 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:COMFORT CARE LIVINGFACILITY NUMBER:
502701015
ADMINISTRATOR/
DIRECTOR:
GORDON, GREGORYFACILITY TYPE:
735
ADDRESS:808 MCHENRY AVETELEPHONE:
(209) 524-0808
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 120CENSUS: 0DATE:
07/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator Gregory Gordon TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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 Analyst (LPA) Jason Lund met with Administrator Gregory Gordon to conducted an annual/required visit. Current Census 0

LPA Lund, Gregory toured/inspected the physical plant. We walked facility including but not limited to the kitchen, residents’ rooms, resident bathrooms, activity rooms, dining room, and courtyard/perimeter. LPA observed that the rooms are equipped with the required furniture and sufficient lighting throughout the facility. Fire extinguishers, smoke detectors, and carbon monoxide detectors were observed in the facility and current. While touring the facility, the LPA observed medication room locked.

No deficiencies were observed during this visit. Exit interview held, copy of report given.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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 1