507001829-8-27-2023-27-AS-APAA-CV4T6U-20230827142742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 507001829
Report Date: 08/26/2023
Date Signed: 08/27/2023 02:28:00 PM

Document Has Been Signed on 08/27/2023 02:28 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:	KANNO'S COMFORT CARE		FACILITY NUMBER:	507001829
ADMINISTRATOR:	JANET KANNO		FACILITY TYPE:	735
ADDRESS:	3602 E ORANGEBURG AVENUE		TELEPHONE:	(209) 526-8934
CITY:	MODESTO	STATE: CA	ZIP CODE:	95355
CAPACITY: 6		CENSUS: 6	DATE:	08/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Saul Kanno		TIME COMPLETED:	01:00 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

On 08/26/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA was greeted by Licensees, Saul Kanno and Janet Kanno and explained the purpose of the visit. This facility is licensed to serve an retain residents who are 18 to 59 years of age. This facility is also vendorized by Valley Mountain Regional Center to serve and retain Level 2 residents at this time. There was one other staff member present at this time, Shelly Vavra.
Current Census was 6. 2 out 6 residents were out on resident outings at this time. This facility was also observed to have been replacing their cracked tiles at the time of this visit.
LPA reviewed 3 resident files.3 out 3 resident files were current and up to date. LPA reviewed 4 staff files. 4 out 4 staff files were current and up to date.
A tour of this facility was conducted.
Fire extinguishers appeared to have been annually inspected on 02/04/2022.

A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet resident needs at this time.

A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time.

LPAs observed a locked centralized stored medication cabinet located in the hallway. Along with the administrator, the LPAs observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

The kitchen area was toured. LPAs observed a sufficient seven days of non-perishable foods as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional refrigerator in the back patio.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: KANNO'S COMFORT CARE	FACILITY NUMBER: 507001829
	VISIT DATE: 08/26/2023

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

The exterior of the physical plant was in good repair with no hazards present. Perimeter fence was observed to be stable and gates were in good repair.

The following forms and documents were requested to be updated and submitted into CCL

-LIC 308

-LIC 400

-LIC 500

-LIC 610

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies are being cited today in violation of California Code of Regulations.

An exit interview was held and a copy of this report was given to the facility at the end of this visit.

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2