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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202491
Report Date: 11/05/2021
Date Signed: 11/08/2021 01:44:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:COMFORT CARE HOME IFACILITY NUMBER:
157202491
ADMINISTRATOR:DHILLON, AMARDEEP (AMY)FACILITY TYPE:
740
ADDRESS:10405 LERWICK AVETELEPHONE:
(661) 663-8433
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 0DATE:
11/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Licensee Amy DhillonTIME COMPLETED:
02:30 PM
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On 11/5/21, Licensing Program Analyst L. Salazar arrived to the facility to conduct a case management visit to observe the closure of the above facility. The licensee has requested the closure of the facility. LPA observed the house with a for sale sign with a lock box on the door. The three (3) residents that were previously residing in this facility, were moved to, Comfort Care Home III Facility #157206712 . This is a 6-Bed facility home, also owned by the Licensee.

LPA will conduct a site visit to Comfort Care III to document the observation and records of residents. LPA requested the following documents from Licensee.

1.) a notice of intent to close
2.) copies of the notices issued to the family of the intended changes
3.) A facility roster (LIC 9020) for new location.
4.) Complete new admission agreements for the transfer


Exit Interview conducted. LPA will initiate the closure of the facility file upon return of the documents. No deficiencies cited on today's visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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