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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700798
Report Date: 02/26/2021
Date Signed: 05/12/2021 08:34:02 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LONNA AND LINA'S COMFORT CARE HOMEFACILITY NUMBER:
392700798
ADMINISTRATOR:JONES, SHALONDAFACILITY TYPE:
740
ADDRESS:2063 S. LINCOLN STTELEPHONE:
(510) 479-6006
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 0DATE:
02/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Shalonda JonesTIME COMPLETED:
04:38 PM
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Licensing Program Analyst (LPA) Johnson arrived at facility and met with licensee to conduct a Case Management visit due to licensee's request to increase facility's capacity and change ambulatory status to 6 non-ambulatory. On 2/24/2021, a fire inspection was conducted and the increase request was granted by the Fire Marshall for (6) six non-ambulatory.

LPA toured the facility and observed the facility to be in substantial compliance. LPA will forward the Fire Marshall (6) non-ambulatory / increase in capacity request and fire inspection approval to Licensing Program Manager for final approval.

Upon approval, LPA will provide licensee an updated license reflecting the increase in capacity.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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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