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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206712
Report Date: 09/29/2022
Date Signed: 09/29/2022 03:26:07 PM

Document Has Been Signed on 09/29/2022 03:26 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: 5DATE:
09/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Amy DhillonTIME COMPLETED:
03:15 PM
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On 9/29/22, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required Infection Control Inspection. LPA Medina met by Licensee, Amy Dhillon stated the purpose of the facility visit. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry.

Tour of the facility conducted. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, facility has 3 private rooms and 1 shared bedroom, shared bedroom has a minimum of 6 feet between beds. LPA observed residents participating in activities during inspection and practicing social distancing. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available.

Fire extinguisher present with a service date of 4/27/22 . LPA observed carbon monoxide detectors and smoke detectors to be operational during today's inspection.

No deficiencies were observed.

Exit interview was conducted. Facility report signed by licensee. Due technical issues Administrator was informed that this report will be emailed.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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