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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006197
Report Date: 01/06/2023
Date Signed: 01/06/2023 03:36:16 PM

Document Has Been Signed on 01/06/2023 03:36 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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MORRIE RESIDENTIAL, INCFACILITY NUMBER:
306006197
ADMINISTRATOR:GARCIA, ANNA CFACILITY TYPE:
735
ADDRESS:11922 MORRIE LANETELEPHONE:
(714) 458-5992
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 4CENSUS: 0DATE:
01/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Anna Garcia, AdministratorTIME COMPLETED:
02:30 PM
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On 01/06/2023 , Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility to conduct a pre-licensing inspection. LPA was greeted and granted entry by licensee Anna Garcia after explaining the purpose of the visit.

An initial application for a license to operate as an Adult Resident Facility was received by the Department on 06/07/2022 for a capacity of 4 ambulatory clients. LPA accompanied by licensee toured the physical plant. Facility is a one-level house with an attached garage, five individual bedrooms, two bathrooms, a kitchen, living room and entryway. There is a small frontyard along with a fenced backyard equipped with a gazebo and swimming pool. The fence securing the access to the pool is noted to be over five feet tall and adequate spacing. The two perimeter gates are observed to be unlocked, self-latching and easy to open in the event of an evacuation.

The four individual bedrooms designated for client use include all necessary components of furnishing including a reading light, a chair, ample storage space for personal items and a queen-size bed or full-size bed as well as a supply of new linen and bedsheets. An additional bedroom will be made available for overnight staff and is not yet fully furnished. There are two shared bathrooms. Facility is clean, sanitary and free of odors in all areas inspected.

The kitchen is equipped with a working refrigerator and freezer. Sample weekly menus are displayed on the refrigerator door. Knives and sharp instruments are shown to be stored in a secure drawer equipped with a functional magnetic lock. An ample supply of non-perishable food items is observed, as well as a water supply and additional water bottles in the event of an emergency. The centrally stored medication will be stored in a secure metal cabinet along with the fully equipped first aid kit, emergency lighting, client records and staff records.
CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MORRIE RESIDENTIAL, INC
FACILITY NUMBER: 306006197
VISIT DATE: 01/06/2023
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CONTINUED FROM FORM LIC809

The required Department postings are posted and present in the common area. The fire extinguisher present is mounted and charged. The fire clearance has been obtained and provided to the Department before the pre-licensing visit. Smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional by licensee.

LPA and licensee toured the outside of the facility and observed it to be free of obstructions. A shaded area is present in the backyard and is equipped with outdoor furniture for the enjoyment of clients and visitors. The perimeter gate present on both sides of the house are self-latching and can easily be open in an evacuation.

No items of non-compliance were identified during today's visit. Component III was waived as licensee already operates two other Adult Resident Facilities. Due to technical difficulty, a copy of this report was emailed to the prospective licensee after the visit to be signed. A scanned signed copy of the report will be attached in an LIC812.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC809 (FAS) - (06/04)
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