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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006498
Report Date: 07/29/2024
Date Signed: 07/29/2024 07:35:30 AM

Document Has Been Signed on 07/29/2024 07:35 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SOUTHERN COMFORT CARE HOMEFACILITY NUMBER:
306006498
ADMINISTRATOR/
DIRECTOR:
CASTEN, LUISITOFACILITY TYPE:
740
ADDRESS:22356 VALDIVIATELEPHONE:
(310) 975-5634
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 0DATE:
07/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:00 AM
MET WITH:Joanne CastenTIME VISIT/
INSPECTION COMPLETED:
07:45 PM
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Licensing Program Analyst (LPA) Jessica Cho conducted an announced subsequent Pre-Licensing continuation visit. LPA Cho was allowed entry and met with Applicant Joanne Casten. The purpose of today's visit was to follow-up on the issues that were present during the initial Pre-Licensing visit on July 24, 2024. The following issues below were observed and required correction:
  • To repair by patching the holes in the ceiling by the half bath and ensuring exit gate self-latches.
  • To deep clean the floor, kitchen, and kitchen appliances, sweep the backyard, wash the outdoor cushions and furniture to remove dust and cobwebs.
  • To remove or cover the exposed cable in the living room and remove the bricks/shelf in the exit passageway.
  • To obtain the current edition of the first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency and the Long Term Care Ombudsman Poster and post it in the entry way.
  • To post a copy of the admission agreement.
  • To label the inspection dates on the fire extinguishers.

Component III is waived due to the applicant previously having a licensed facility and having completed Component III. LPA provided a refresher consultation answering questions for the Applicant during the visit.

On today's visit the aforementioned items have been addressed and corrected. The aforementioned items reviewed during this visit are in compliance. The Pre-Licensing is now complete. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

An exit interview was conducted, and a copy of this report was provided at the time of this visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2024
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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