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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206712
Report Date: 09/30/2021
Date Signed: 11/08/2021 01:55:35 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/08/2021 01:55 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
CCLD Regional Office, 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: 0DATE:
09/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Amy Dhillon, LicenseeTIME COMPLETED:
04:00 PM
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On 09/30/2021, Licensing Program Analyst (LPA) L. Salazar arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility by licensee. Facility has one entry/exit point. Visitor log-in/temperature check observed at the entrance of the facility.

Facility has no residents at this time, however, the facility is in the process of closing a sister facility and relocating three (3) residents to this location from Comfort Care Home 1. LPA did not observe obstructions or fire clearance issues. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathroom had a trash cans with lid. Signs promoting social distancing, cough/sneeze etiquette, and hand-washing observed. 2 out of 5 bedrooms were designated for single occupancy during this inspection.

LPA observed a medication cabinet with a lock for future medications. Cleaning and PPE supplies were checked. Facility has a 30 day supply of required PPE. Residents will wear masks when away from the facility. Resident’s files have updated emergency contact information.



No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed to Licensee.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2021
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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