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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203990
Report Date: 09/22/2023
Date Signed: 09/22/2023 11:17:51 AM

Document Has Been Signed on 09/22/2023 11:17 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:ALLISON MORGAN RESIDENCEFACILITY NUMBER:
157203990
ADMINISTRATOR:ALLISON, KEVINFACILITY TYPE:
735
ADDRESS:7308 STELLA COURTTELEPHONE:
(661) 679-4946
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 3CENSUS: 3DATE:
09/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Kevin AllisonTIME COMPLETED:
11:23 AM
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On 9/22/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by Tori Morgan. LPA conducted facility tour with Tori Morgan and Kevin Allison. Kevin Allison also serves as facility Administrator, certificate #66011200735, expires 1/17/2024, CPR/First Aid expires 12/2023.

All three residents were at day program during today's inspection.

LPA conducted a complete tour of the facility. Facility was observed at a comfortable temperature. The tour started in the residents' rooms. Residents bedrooms were observed to be adequately furnished with bed, dresser, and adequate lightning. Kitchen toured, LPA observed to have adequate supply for residents in care. Bathrooms were properly equipped and fixtures operational. Hot water was tested at 120 degrees F in the bathrooms. Common areas were properly furnished and well-lit throughout. All medications observed to be locked and stored in kitchen cabinet. Medications observed to have original labels and be administered as prescribed.

Fire extinguisher was observed with a with purchase date of 4/19/2023. Smoke detector observed operational during today's inspection. Cleaning supplies and chemicals were observed in the locked under kitchen sink.

Outside of facility toured. All exits open free of obstruction. Pool observed to be locked and secured with a perimeter gate and not accessible to residents.

No deficiency was observed. Exit Interview conducted and a copy of report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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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