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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209038
Report Date: 06/30/2023
Date Signed: 06/30/2023 10:36:12 AM

Document Has Been Signed on 06/30/2023 10:36 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: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:
06/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:TIME COMPLETED:
10:35 AM
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On 06/30/2023, Licensing Program Analyst (LPA) Walton arrived unannounced and attempted to conduct an annual inspection. Due to a prior commitment, Administrator is unable to conduct today's inspection. LPA will return at a later date to complete the annual inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2023
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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