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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426081
Report Date: 03/24/2022
Date Signed: 03/24/2022 01:47:18 PM

Document Has Been Signed on 03/24/2022 01:47 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:COMFORT HOME 2FACILITY NUMBER:
366426081
ADMINISTRATOR:LAL, HARISH K.FACILITY TYPE:
740
ADDRESS:7092 PROVIDENCE WAYTELEPHONE:
(909) 371-3427
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 6CENSUS: 5DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Sushma Harish-LicenseeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Gardner met with Caretaker Maria Padilla who confirmed that there are currently no cases/exposures of COVID-19 within the facility. At the time of visit there were two (2) staff, and five (5) residents present. Ms. Padilla called Licensee Sushma Lal who showed up to the facility to complete todays visit. LPA Gardner went over COVID-19 best practices for infection control and prevention with Ms. Lal. Residents have hand sanitizer available to them and the bathrooms were stocked with hand soap and paper towels. LPA Gardner observed the facility to have multiple postings throughout the facility for cough etiquette, proper hand washing procedure, social distancing, and emergency contact information for residents has been updated. LPA Gardner requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located in the garage. Ms. Lal has a full 30-day supply of PPE items such as gloves, face shields, gowns, surgical masks, N95 masks, disinfectant, and hand sanitizer supply. LPA Gardner discussed creating a box, or similar, to have a supply of PPE ready that would be dedicated for an isolation room, along with a trash can to put inside and outside of an isolation room. Ms. Lal created an isolation box during todays visit. LPA Gardner inquired as to if staff have been fit tested for N95 masks, and Ms. Lal stated their staff have not been fit tested yet. LPA Gardner will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. All residents and staff are practicing all other COVID-19 precautions, which minimize the risk of them contracting COVID-19. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Ms. Lal along with a copy of the TA Advisory Note.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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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