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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209147
Report Date: 10/25/2023
Date Signed: 10/25/2023 11:32:02 AM

Document Has Been Signed on 10/25/2023 11:32 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 #1FACILITY NUMBER:
547209147
ADMINISTRATOR:DURAN, ANDREA & GURROLA, MFACILITY TYPE:
735
ADDRESS:1300 STATE ST.TELEPHONE:
(559) 719-7484
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 4DATE:
10/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Andrea DuranTIME COMPLETED:
11:40 AM
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On 10/25/23, Licensing Program Analyst (LPA) M. Medina conducted an Annual/Required visit. LPA met with Administrator, Andrea Duran.

Currently, there are four (4) clients in care. All clients were at Day Program at time of visits, clients attend day program Monday - Friday 8:00 AM - 3:00 PM, all transportation provided by day program.

Facility tour conducted. Facility observed to be clean and odor free. Adequate seating and lighting observed in both the living room, family room and dining room. Client bedrooms have all required accommodations. Client bathroom toured, LPA measured water temperature 109 degrees F. Kitchen toured, LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food. Medications observed to be kept in a locked cabinet in medication area. Client medications were reviewed. All medication have their original labels and appear to be administered as ordered. All cleaning supplies are locked and secured in cabinet in laundry room. Smoke detectors and carbon monoxide observed to be operational during today's inspection. Fire extinguisher present with a service date of 4/21/2023. Last fire drill conducted on 10/02/2023 according to facility records.

Outside of facility toured. Pool is locked, secured, and inaccessible to residents. All exits open free of obstruction, no hazards observed.

LPA received the following documents during inspection: Copy of Administrator Certificate, LIC 308, LIC 500, LIC 610, Affidavit Regarding Client Cash Resources, Administrative Organization, and Surety Bond.

No deficiencies cited during today's visit. Exit interview conducted and a copy of report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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