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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206712
Report Date: 08/02/2023
Date Signed: 08/02/2023 01:46:57 PM


Document Has Been Signed on 08/02/2023 01:46 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 IIIFACILITY NUMBER:
157206712
ADMINISTRATOR:DHILLON, AMARDEEP (AMY)FACILITY TYPE:
740
ADDRESS:9609 GHIRADELLI DRTELEPHONE:
(661) 204-4455
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 6DATE:
08/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Amy Dhillon, Licensee/AdministratorTIME COMPLETED:
02:00 PM
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On 08/02/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a Annual
visit. LPA introduced self, stated the purpose of the visit, and was greeted by Licensee/Administrator Amy Dhillon. LPA was granted entry into the facility. All six residents were present during inspection.

The tour started in the kitchen into the common areas, to residents’ bedrooms, and bathrooms. The facility was observed to be at a comfortable temperature of 75 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Refrigerated temperature maintained at 39 degrees F and freezer temperature maintained at -9 degrees F. Fire extinguisher was observed with a service date of: 02/27/23. Fire drill last completed on 04/5/23. Medications are kept locked in laundry cabinet. MARs were reviewed. Cleaning chemicals observed locked in laundry shelves and in garage.

LPA toured all resident’s bedrooms and observed 2 single occupant rooms and 2 shared bedrooms. Residents’ room observed to be adequately furnished with bed, dresser, and adequate lighting. Bathrooms were properly equipped, and the hot water temperature was tested range between 105.4 and 106.3 degrees F in shared master bathroom and 107.6 degrees F in bathroom 1. Outside of facility toured. Side gate was self-closing and self-latching. All residents’ file reviewed to have update emergency contacts, Admission agreement, and Pre-Appraisal. Staff files were also reviewed. Staff files were observed to have current First Aid/CPR, Health screening, and Personnel record. Staff are fingerprinted clear and associated to the facility. Smoke detectors were tested and observed to be operational.

No deficiency cited during inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 8/8/23. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, Lic 9282, control of property, current liability insurance, and current Administrator Certificate. A copy of this report was provided to Licensee.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
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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