157206712-1-31-2024-24-AS-SMOA-D26PET-20240205101539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157206712
Report Date: 01/31/2024
Date Signed: 01/31/2024 10:20:03 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
01/19/2024 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240119151633

FACILITY NAME:	COMFORT CARE HOME III		FACILITY NUMBER:	157206712
ADMINISTRATOR:	DHILLON, AMARDEEP (AMY)		FACILITY TYPE:	740
ADDRESS:	9609 GHIRARDELLI DR		TELEPHONE:	(661) 858-0434
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	6	CENSUS: 5	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Maria Edna Agatep, Staff		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff does not provide nutritious meals to residents.
Facility does not post menu.

INVESTIGATION FINDINGS:

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On 01/31/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with staff Maria Edna Agatep. Staff informed LPA Administrator is unavailable and out of the country.

During the course of the investigation, the Department conducted interviews, reviewed records, and toured the facility. Food is delivered once a week and as needed to the facility. Adequate nonperishable and perishable food were observed. Two different menus were observed posted on the refrigerator.

Based on observation, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to staff whose signature confirms receipt of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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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