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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209038
Report Date: 07/31/2023
Date Signed: 07/31/2023 10:29:00 AM

Document Has Been Signed on 07/31/2023 10:29 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: 4DATE:
07/31/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Administrator, Dana SchraderTIME COMPLETED:
10:42 AM
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On 07/31/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Dana Schrader.

LPA conducted a tour of the facility with Administrator. During the inspection the facility appeared clean and odor free and at a comfortable temperature. Common areas were furnished and had adequate seating and lighting available. Resident bedrooms appeared clean and had required furnishings and adequate lighting. Residents bathrooms appeared clean, water temperature measured at 119.5 degrees F in bathroom 1 and 116.8 degrees F in bathroom 2. Facility kitchen appeared to be clean and safe for food preparation. LPA observed 2-day supply of perishable foods and a 7-day supply of non-perishable food.

Exterior tour conducted, all exits open and free of obstructions during today’s visit. Fire extinguisher is current, last serviced on 07/02/2023. Smoke detectors and carbon monoxide detector observed to operational. Last fire drill conducted on 04/22/2023. Cleaning supplies observed to be locked and inaccessible to residents in care. LPA reviewed client and staff files. Medications observed to be locked and administered as prescribed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 08/14/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Dana Schrader, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
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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