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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206711
Report Date: 09/30/2021
Date Signed: 10/01/2021 02:54:37 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 IIFACILITY NUMBER:
157206711
ADMINISTRATOR:DHILLON, AMYFACILITY TYPE:
740
ADDRESS:9613 GHIRARDELLI DRIVETELEPHONE:
(661) 204-4455
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 5DATE:
09/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Amy Dhillon, Licensee TIME COMPLETED:
03:30 PM
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On 09/30/2021, Licensing Program Analyst (LPA) L. Salazar arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility by . LPA met with Licensee. Facility has one entry/exit point. Visitor log-in/temperature check observed at the entrance of the facility.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathroom had a trash cans with lid. Signs promoting social distancing, cough/sneeze etiquette, and hand-washing observed. 2 out of 4 bedrooms were single occupancy during this inspection.

LPAs checked residents’ locked medications. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Facility has a 30 day supply of required PPE. Staff records were reviewed for good health and infection control training. Residents wear masks when away from the facility. Resident’s files have updated emergency contact information.



No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed and an electronic signature will confirm receipt of this document.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (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.
LIC809 (FAS) - (06/04)
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