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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209038
Report Date: 06/18/2022
Date Signed: 07/11/2022 02:21:47 PM

Document Has Been Signed on 07/11/2022 02:21 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:D&I MORRIS HOME #2FACILITY NUMBER:
547209038
ADMINISTRATOR:RODRIGUEZ, RENEEFACILITY TYPE:
735
ADDRESS:270 N. ANDERSON RDTELEPHONE:
(559) 359-3301
CITY:EXETERSTATE: CAZIP CODE:
93221
CAPACITY: 4CENSUS: DATE:
06/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:TIME COMPLETED:
09:30 AM
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Licensing Program Analyst Shawna Doucette attempted to conduct an annual inspection on this date at the facility. LPA was unable to make contact with the Administrator. LPA attempted to contact via phone and left a voicemail.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2022
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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