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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006547
Report Date: 11/15/2024
Date Signed: 11/15/2024 10:36:29 AM

Document Has Been Signed on 11/15/2024 10:36 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:COMFORT FIRST HOME CAREFACILITY NUMBER:
306006547
ADMINISTRATOR/
DIRECTOR:		PHAM, MINHFACILITY TYPE:
740
ADDRESS:645 S MAGNOLIA AVETELEPHONE:
(714) 244-5687
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 6CENSUS: 0DATE:
11/15/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Minh Pham, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Rose Ruppert and Fred Arias made an announced visit to the facility at 8:00 AM for the purpose of conducting a pre-licensing inspection. LPAs met with Administrator (AD) Minh Pham. An application to operate a Residential Care Facility for the Elderly (RCFE) for a capacity of six residents with five non-ambulatory and one ambulatory was received on April 3, 2024. There are no residents in care.

The facility is a six bedroom, five bathroom single-story building. The six residents will occupy three shared bedrooms in the rear of the home. LPAs observed there were no auditory alarms on the non-ambulatory room exits but each bedroom had a call button by the entry doors. Two additional bedrooms are occupied by others: one caretaker who is background cleared and a renter who is not. Administrator will work on background clearance for the renter who lives on the property. There is an additional empty bedroom with three beds that will not be used for residents or staff at this time. The facility eventually plans to expand their capacity with a new fire clearance in the future. All bedrooms had the required furnishings and bathrooms all had grab bars and tight fitting closed trash cans.



During today’s visit, LPAs toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperatures in four of four resident bathrooms. The hot water temperature measured between 112.8 and 119.1 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational and are interconnected throughout the facility. The fire extinguishers are charged but no service dates were attached. AD will get fire extinguishers serviced. The living room fireplace does not have a screen and AD will purchase a screen. LPAs inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPAs observed sharps were not secured so AD will install locks to secure knives in the kitchen. All cleaning supplies were secured in a locked closet.

(Continued on LIC 809-C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: COMFORT FIRST HOME CARE
FACILITY NUMBER: 306006547
VISIT DATE: 11/15/2024
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(Continued from LIC 809)

LPAs observed the "See Something, Say Something" PUB 475 poster was prominently posted and is the required size. The Emergency Disaster plan, facility sketch, Theft and Loss, Personal Rights and Resident Councils documents were posted in the entry way. LPAs observed the First Aid Kit had all the required elements and a First Aid manual. AD will purchase additional water bottles for Emergencies.

While touring the exterior LPAs noted there was not a shaded seating area for residents. AD mentioned he would create a shaded area. LPAs noted there are no exterior backyard gates and the AD disclosed that the property is gated and the entry gate will always be closed and that there is a call button at the entry gate.
LPAs confirmed that administrator has a current administrator certificate which expires on June 24, 2026.

LPAs conducted the Component Three Orientation with AD. AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento after repairs and corrections are completed. AD will notify LPAs when corrections are completed. An exit interview was conducted and a copy of this report was provided to Licensee.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
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