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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206689
Report Date: 09/28/2023
Date Signed: 09/28/2023 04:50:19 PM

Substantiated


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
09/25/2023 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20230925093428
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: 6DATE:
09/28/2023
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Evangeline SchisslerTIME COMPLETED:
05:06 PM
ALLEGATION(S):
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Staff are not present during the night
INVESTIGATION FINDINGS:
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On 9/28/23, Licensing Program Analyst (LPA) M. Medina arrived unannounced to commence a complaint investigation. LPA introduced self, stated purpose of visit and allowed entrance by caregiver. Licensee, Evangeline Schissler arrived a few minutes later to conduct visit.

LPA toured facility, conducted interviews, and reviewed documentation. Based on interviews staff are not present at night, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

An immediate civil penalty of $500 is assessed.

Exit interview conducted. Exit interview conducted and a copy of this report was provided for facility records.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
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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Control Number 24-AS-20230925093428
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: A COMFORT CARE HOME
FACILITY NUMBER: 157206689
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/28/2023
Section Cited
HSC
1569.2(c)
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"Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental
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Licensee will have staff present at night beginining 9/28/23 until a night staff is hired.
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health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. ***This was not met as evidenced by LPA interviews that staff are not present at night.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2