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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011441035
Report Date: 01/24/2024
Date Signed: 01/24/2024 09:58:51 AM


Document Has Been Signed on 01/24/2024 09:58 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:COMFORT CARE HOMEFACILITY NUMBER:
011441035
ADMINISTRATOR:CAINGCOY, RUFINAFACILITY TYPE:
740
ADDRESS:24931 JOYCE STREETTELEPHONE:
(650) 766-1814
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:6CENSUS: 0DATE:
01/24/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jenilee PatalotTIME COMPLETED:
10:30 AM
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On this day at around 10am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived to conduct case management closure visit and met with Administrator Jenilee Patalot.

During the visit, LPA inspected the facility inside and out and did not observe any resident. The facility is currently being renovated.

The Administrator surrendered the facility license and provided LPA with a new mailing address.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024
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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