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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209038
Report Date: 06/19/2024
Date Signed: 06/19/2024 10:40:48 AM

Document Has Been Signed on 06/19/2024 10:40 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/
DIRECTOR:		RODRIGUEZ, RENEEFACILITY TYPE:
735
ADDRESS:270 N. ANDERSON RDTELEPHONE:
(559) 359-3301
CITY:EXETERSTATE: CAZIP CODE:
93221
CAPACITY: 4CENSUS: 4DATE:
06/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:37 AM
MET WITH:Administrator, Dana SchraderTIME VISIT/
INSPECTION COMPLETED:
10:48 AM
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On 06/19/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self and was granted entry to the facility by facility staff Emily Knight. Facility staff contacted Administrator, Dana Schrader via telephone. Administrator arrived a short time later.

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 118.9 degrees F in the bathroom near the kitchen and and 117.2 degrees F in the bathroom near bedrooms 2 and 3. 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 04/15/2024. Cleaning supplies observed to be locked and inaccessible to clients in care. LPA reviewed client and staff files. 4 out of 4 clients did not have a complete medical assessment on record. Medications observed to be locked and administered as prescribed. Interviews revealed that Dana Schrader is the new administrator for the facility. LPA is requesting that the facility submit change of administrator documentation to the Fresno CCL office by 06/26/2024.

LPA is requesting the following documents be submitted to the Fresno CCL office by 07/03/2024: 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, and Surety Bond.

A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were 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: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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Document Has Been Signed on 06/19/2024 10:40 AM - It Cannot Be Edited


Created By: Alexandria Walton On 06/19/2024 at 10:30 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: D&I MORRIS HOME #2
FACILITY NUMBER: 547209038

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80069(b)
Client Medical Assessments
(b) In ARFs, prior to accepting a client into care, the licensee shall obtain and keep on file documentation of the client's medical assessment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above when 4 out of 4 clients did not have a medical assessment on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/19/2024
Plan of Correction
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Licensee agrees to obtain a medical assessment for 4 out of 4 clients and submit a copy of the medical assessment to the Fresno CCL office by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024


LIC809 (FAS) - (06/04)
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