157202491-10-1-2021-24-AS-MHON-C7RPTM-20211013113610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157202491
Report Date: 09/30/2021
Date Signed: 10/01/2021 02:58:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2021 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20210427122356

FACILITY NAME:	COMFORT CARE HOME I		FACILITY NUMBER:	157202491
ADMINISTRATOR:	DHILLON, AMARDEEP (AMY)		FACILITY TYPE:	740
ADDRESS:	10405 LERWICK AVE		TELEPHONE:	(661) 663-8433
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	6	CENSUS: 3	DATE:	09/30/2021
		UNANNOUNCED	TIME BEGAN:	03:57 PM
MET WITH:	Licensee Amy Dhillon		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not address a resident's change in medical condition
Staff is unable to communicate effectively with the residents
Staff are not providing appropriate care and supervision to residents

INVESTIGATION FINDINGS:

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On 09/30/2021, Licensing Program Analyst (LPA), L. Salazar arrived at the facility unannounced to deliver findings on the above allegations.

LPA conducted interviews with staff and residents. LPA observed physician reports, facility communication logs, medication administration records staff training and roster.

Based on the information received, the Department has found that the complaint is UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

No deficiencies cited and exit interview was conducted. A copy of this signed report will be sent electronically vis email to amysdhillon1@aol.com.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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