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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206711
Report Date: 09/29/2022
Date Signed: 09/29/2022 01:41:38 PM


Document Has Been Signed on 09/29/2022 01:41 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: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: 4DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:51 PM
MET WITH:Amy DhillonTIME COMPLETED:
01:43 PM
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On 9/29/2022, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA met with Licensee/Administrator Amy Dhillon and stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place.

Facility appeared clean with no obstruction or fire clearance issues. Visitor sign-in book, masks, and hand sanitizer was readily available to visitors. 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, currently 1 shared room and 2 private bedrooms. Resident bedrooms with 2 occupants observed to have a minimum of 6 feet between beds. Kitchen toured, food supply observed to be adequate for residents in care.

Fire extinguisher present and has a service date of 04/27/2022. Carbon monoxide detector and smoke detectors present and observed to be operational during today's inspection.

No deficiencies observed during inspection.

Exit interview conducted. Report signed by Administrator and a copy of this 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: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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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