198320510-11-21-2024-11-AS-WGIS-DB8SKX-20241121125728

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320510
Report Date: 11/21/2024
Date Signed: 11/21/2024 12:57:40 PM

Document Has Been Signed on 11/21/2024 12:57 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	COMFY CARE HOME, INC		FACILITY NUMBER:	198320510
ADMINISTRATOR/ DIRECTOR:	BUNAG, ZENAIDA		FACILITY TYPE:	740
ADDRESS:	22620 MADISON ST		TELEPHONE:	(310) 930-6455
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY: 6		CENSUS: 0	DATE:	11/21/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:04 AM
MET WITH:	Zenaida Bunag		TIME VISIT/ INSPECTION 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 11/21/2024, the department conducted a scheduled pre-licensing visit to the facility listed above. LPA met with Licensee, Zenaida Bunag, and Administrator, May Drapeau, and the purpose of today’s visit was explained. An Initial Application was submitted on 06/30/24. The facility has received an approved fire clearance for three (3) non-ambulatory residents and three (3) bedridden residents with a total capacity of six (6) residents. Structure/Physical Plant The facility is a single-story home in a residential neighborhood. The home consists of four (4) bedrooms, two (2) full bathrooms and ½ bathroom, kitchen, dining room, living room, office/receiving area, attached garage, front and backyard. The backyard has a shaded patio with chairs and table. The front and backyard are in good repair. All walkways outside were observed clean, clear, and free of obstructions, debris, and hazards. Gates on the side of the home open easily from the inside to exit. There are no bodies of water observed on the premises. Bedrooms The department inspected all resident bedrooms. The department observed all bedrooms to have the required items including a bed(s), dresser(s), nightstand(s) with lamp, chair(s), and ample storage space for resident use. All beds had the required linens, including a mattress cover, fitted sheets, blanket, comforter, and pillows. The department observed an ample supply of bed linens stored in a cabinet in the garage. All bedrooms were observed to be in good repair.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COMFY CARE HOME, INC	FACILITY NUMBER: 198320510
	VISIT DATE: 11/21/2024

NARRATIVE

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Bathrooms The department inspected all resident bathrooms. All bathrooms were found to be within Title 22 regulations. All bathrooms were observed to be clean and operable. All showers had secured safety handrails, nonskid matts, and shower chairs available. The water temperature measured 108.5-degrees, 105.1-degrees, and 108.8-degrees Fahrenheit. The department observed hygiene products secured in a cabinet in the garage. The department observed an ample supply of towels in a cabinet in the garage.
Kitchen The department inspected the kitchen and found it to be clean and sanitary. The department observed an ample supply of cookware, dishware, and cutleries in good repair. The department observed a 2-day supply of perishable foods and a 7-day supply of nonperishable foods properly stored. The department observed all sharps and knives secured in a locked drawer and are inaccessible to residents. The department observed all cleaning supplies secured in a locked cabinet under the kitchen sink. The water temperature measured 108.8-degrees Fahrenheit.
Common Areas The department inspected all common areas. The dining room has a large table with chairs to accommodate all residents. The living room has a couch and chairs to accommodate residents. The department observe a fireplace that is screened, and inaccessible to residents. The department observed games, puzzles, books, and reading material available for residents in the living room. The department observed a desk, couch, and chair in the receiving area. All rooms were observed to have ample lighting. All walkways and hallways were observed clean, clear, and free of obstructions and hazards. The facility was maintained at a

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COMFY CARE HOME, INC	FACILITY NUMBER: 198320510
	VISIT DATE: 11/21/2024

NARRATIVE

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comfortable temperature.
Medications/Files The department observed a secured locked cabinet in the receiving/office area where all Centrally Stored Medications will be secured and will be inaccessible to residents. The department observed a locked file cabinet in the receiving/office area where resident and staff files will be secured and will be inaccessible to residents.
Safety The department observed three (3) fully charged fire extinguishers recently purchased. One extinguisher was mounted in the kitchen, another was mounted in the garage and the third is mounted in the hallway near the bedrooms. The smoke detectors are hardwired and fully operational. The department observed and tested four (4) carbon monoxide detector. All rooms have a facility sketch that shows emergency exits. All doors exiting the facility have a sensor that alerts when a door is opened. The department observed all exits are indicated with an EXIT sign. The department inspected the First Aid Kit and found it contained all the required items and a current manual. The facility has a working landline telephone. The department observed all required state posting throughout the facility. There are no firearms or ammunition stored at the facility.
Infection Control During today’s visit, The department observed the facility’s infection control practices. At the entrance there are sanitizing stations that has hand sanitizer, masks, and a visitor log. The department observed Infection Control signs posted throughout the facility. The department observed a 30-day supply of PPEs stored in the garage.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COMFY CARE HOME, INC	FACILITY NUMBER: 198320510
	VISIT DATE: 11/21/2024

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	Component III was reviewed and discussed with Licensee and Administrator. During today’s visit, the department did not observe any advisory recommendations. An exit interview was conducted with Licensee/Administrator, Zenaida Bunag, and Administrator, May Drapeau and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC809 (FAS) - (06/04)

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