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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209124
Report Date: 05/22/2024
Date Signed: 05/22/2024 12:31:05 PM

Document Has Been Signed on 05/22/2024 12:31 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: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: 4DATE:
05/22/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Administrator, Andrea DuranTIME VISIT/
INSPECTION COMPLETED:
12:41 PM
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On 05/22/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual continuation inspection. LPA contacted Administrator via telephone. LPA introduced self and disclosed the purpose of the visit. Administrator arrived to the facility a short time later and LPA was granted entry to the facility. LPA met with Administrator, Andrea Duran.

There were no clients present during today's inspection. Per Administrator, clients were in the community.

LPA conducted a tour of the facility. During the inspection the facility appeared clean, 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 111.7 degrees F. Facility kitchen appeared to be clean and safe for food preparation. LPA observed 2-day supply of perishable food and a 7-day supply of non-perishable food.

Exterior tour conducted, all exits open and free of obstructions on today’s visit. Fire extinguisher is current with a service date of 04/11/2024. Smoke detectors and carbon monoxide detector observed to operational. Last fire drill conducted on 05/01/2024 and the last disaster drill was conducted on 04/02/2024. LPA reviewed client and staff files. Medications observed to be administered as prescribed and inaccessible to clients in care.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Andrea Duran, whose signature on this form confirm receipt of this document.

LPA is requesting the following documents be submitted to the Fresno CCL office by 06/05/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610D) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A), Surety Bond

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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