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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700798
Report Date: 07/20/2021
Date Signed: 07/20/2021 12:12:47 PM

COMPREHENSIVE INSPECTION
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:
07/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Shalonda JonesTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Johnson arrived at facility and met with licensee to conduct an annual inspection visit.

Licensee informed LPA that she will be closing the facility. The facility has not had any referrals and no interest. 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 requested the facility submit a closing survey.

Exit interview.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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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