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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209393
Report Date: 05/02/2024
Date Signed: 05/03/2024 12:15:35 AM

Document Has Been Signed on 05/03/2024 12:15 AM - 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:A COMFORT CARE HOME -1FACILITY NUMBER:
157209393
ADMINISTRATOR/
DIRECTOR:		SCHISSLER, EVANGELINEFACILITY TYPE:
740
ADDRESS:6918 NORMANDY ROSE AVETELEPHONE:
(323) 237-4781
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 8CENSUS: 0DATE:
05/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:54 AM
MET WITH:Evangeline Schissler, Licensee TIME VISIT/
INSPECTION COMPLETED:
02:09 PM
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On 05/02/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility for an announced pre licensing inspection. LPA was greeted by Licensee/Administrator and was allowed entry into the facility.

LPA toured the facility inside and out with licensee. LPA entered through the front door and did not observe the required postings in the entry. LPA observed the residence to be a single story, 4 bedroom/ 2 bathroom home. Deadbolt locks were observed on 3 out of the emergency exits and will need to be removed. There is a dining room and living room observed to have adequate furnishings and lighting. All bedrooms were observed to have beds, however, 4 out of 4 bedrooms did not have night stands, personal lighting and chest drawers to accommodate 2 residents per room.

LPA observed fire extinguisher to be new and charged, however, no service or purchase date was provided on the extinguisher. Smoke detectors were tested and observed to be operational. Carbon Monoxide detectors were not observed. Emergency lighting /flashlights and night lights in the hallways by the bathrooms were not observed. Licensee will purchase.

LPA observed a adequate supply of towels. There were no hand washing signs observed. A supply of paper towels were observed in the bathrooms. Hot water temperature in bathroom measured at 128.4 degrees F. Non-Skid mats were not present in the shower. Grab bars were observed in the bathrooms next to the toilets and showers.

Kitchen observed to have supply of dishes, plates, pots and pans. Microwave and underneath cabinet next to stove needs to be degreased/cleaned. Food storage and preparation areas are clear and appropriate for food preparation. Cleaning supplies and chemicals are locked in the garage. A locked cabinet in the kitchen is designated to store medications. Sharps/knives were observed in a locked drawer in the kitchen. Appliances observed to be in working order. LPA observed a 7 day supply of non-perishable food.
(continued on LIC809-C)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: A COMFORT CARE HOME -1
FACILITY NUMBER: 157209393
VISIT DATE: 05/02/2024
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(Continued from LIC 809)

First aid kit was not observed. Washer and Dryer observed in the laundry room with additional storage space available in upper cabinets. Doors and passageways are clear and free from obstruction throughout the home. LPA toured the outside of the residence and observed a patio to be uncovered. Adequate outdoor seating for activities. A self-latching gate found to be working properly. There are no bodies of water on the premises.


The following observed will need to be brought into compliance:
Chest of drawers for each resident
Night stand for each resident
Obtain first aid kit
Microwave and underneath cabinet next to stove needs to be degreased/cleaned
Turn down the water heater so temperature is under 120 degrees F
Obtain telephone line service at the facility and provide phone number to CCL
Proof of Fire Extinguisher in compliance
Purchase Carbon monoxide detectors
Posting of Fire Clearance, PUB 475, Resident rights, Visiting Policy
Provide paper towels for bathrooms
Purchase adequate food supply for 7 days
Install night lights in hallway
Patio needs covering for seating area.
Deadbolt locks need to be removed on 3 out of 3 emergency exits
Weather stripping on door exiting to backyard needs a section replaced
Update the emergency disaster plan (LIC 610D) to reflect specific steps of what the facility will do in the event of an emergency disaster.

An exit interview was conducted and a copy of this report was left with licensee, whose signature confirms receipt of these documents.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
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