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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206689
Report Date: 07/20/2022
Date Signed: 07/20/2022 03:38:53 PM


Document Has Been Signed on 07/20/2022 03:38 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, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:A COMFORT CARE HOMEFACILITY NUMBER:
157206689
ADMINISTRATOR:SCHISSLER, EVANGELINE T.FACILITY TYPE:
740
ADDRESS:12409 ANDES AVETELEPHONE:
(323) 237-4781
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 5DATE:
07/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Evangeline SchisslerTIME COMPLETED:
03:50 PM
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On 7/20/2022, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self and allowed entrance by Licensee/Administrator Evangeline Schissler. Facility tour conducted, COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point, all staff and visitors enter through front door.

Five (5) residents observed to be present during today's inspection. Facility appeared clean with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, all resident bedrooms observed to have as minimum of 6 feet between beds. All common areas having adequate seating and lighting for residents. Food supply is adequate to meet regulation. All medications observed to be locked and secured, all resident have a 30-day supply available. Facility has adequate supply of PPE available in office.

No deficiencies observed during inspection.

Exit interview conducted. Facility report signed at time of inspection. Copy of report provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
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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