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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206711
Report Date: 09/25/2024
Date Signed: 09/25/2024 01:23:00 PM


Document Has Been Signed on 09/25/2024 01:23 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
SIERRA CASCADE AC/SC, 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) 858-0431
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 6DATE:
09/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Licensee Amy DhillonTIME COMPLETED:
01:30 PM
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On 09/25/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit.
introduce self, stated the purpose of the visit and met with Licensee/Administrator Amy Dhillon. LPA toured facility with Licensee. All six residents were present during inspection. Three residents sitting in the common area and three in their bedrooms.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Fire extinguisher was observed with a service date: 03/07/24. An adequate supply of perishable and non-perishable food was observed. Refrigerator temperature is maintained at 30 degrees F and freezer at -11 degrees F.

Cleaning supplies and chemicals stored and locked under kitchen sink and in laundry room shelf. Medications were observed locked in laundry room shelf and kitchen shelf. Extra linens were observed in hall closet. All bedrooms were observed to have the required furnishings and with adequate lighting. The bathrooms were toured. Non-skid mat and grabbed bars were observed. Hot water temperature was tested at 109.2 and 109 degree F in the master bathroom and 108 degree F in hall bathroom.

Outside of facility toured and observed to be free of debris. Adequate outdoor seatings available for residents. Side gate observed self-latching and self-closing. Smoke detectors and carbon monoxide were observed operational during visit. Sample of residents’ and staff files were reviewed.

No deficiency cited during visit.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 10/01/24. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, current liability insurance, and control of property. A copy of this report was provided to Licensee, whose signature confirms received of this report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
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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