<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206689
Report Date: 07/24/2023
Date Signed: 07/25/2023 08:35:39 AM


Document Has Been Signed on 07/25/2023 08:35 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, 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:
07/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Evangeline SchisslerTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) M. Medina made an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by Direct Care staff. Administrator, Evangeline Schissler arrived a short time later to conduct inspection visit.

Facility tour began in resident bedrooms. Rooms observed to have all required accommodations. All areas of the facility have sufficient lighting. Residents bathrooms observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Hot water tested in resident bathroom with a water temperature of 120 degrees F. Dining room and living room have adequate seating and lighting for all residents in care. Tour of kitchen conducted. LPA observed adequate food supply for the residents in care. Medications observed to be locked in small cabinet in hallway.

Smoke detectors and carbon monoxide detectors present and observed operational during today's inspection. Fire extinguisher has a service date of 07/27/22. All cleaning supplies are locked and secured in garage.

Outside areas toured. All exits open freely and observed to be free of obstruction. No hazards observed. Pool is secured with a locked 6 foot wrought iron fence and inaccessible to residents.

Licensee to submit current LIC 500, LIC 610, LIC 9020, and Liability insurance to Fresno CCL office no later than 8/4/23.

Due to time constraints staff and resident files will be reviewed at a later date.

No deficiencies cited during inspection.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1