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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209124
Report Date: 04/24/2024
Date Signed: 04/24/2024 10:59:29 AM

Document Has Been Signed on 04/24/2024 10:59 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:GURROLA CARE HOME #6FACILITY NUMBER:
547209124
ADMINISTRATOR/
DIRECTOR:		DURAN, ANDREAFACILITY TYPE:
735
ADDRESS:343 S. MIRAGETELEPHONE:
(559) 719-7484
CITY:LINDSAYSTATE: CAZIP CODE:
93247
CAPACITY: 4CENSUS: DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Licensee, Mary Ellen Gurrola via telephoneTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 04/24/2024, Licensing Program Analyst (LPA) arrived unannounced and attempted to conduct an annual inspection. LPA knocked on the door and rang the doorbell with no response. LPA contacted Licensee Mary Ellen Gurrola via telephone. Administrators are unable to attend this inspection. There are no staff or residents present upon arrival.

An annual continuation visit will be conducted at a later date.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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