<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209171
Report Date: 10/25/2023
Date Signed: 10/25/2023 01:59:53 PM


Document Has Been Signed on 10/25/2023 01:59 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 #3FACILITY NUMBER:
547209171
ADMINISTRATOR:GURROLA, MARY ELLENFACILITY TYPE:
740
ADDRESS:287 TEAPOT DOME #BTELEPHONE:
(559) 719-7484
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:4CENSUS: 4DATE:
10/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Mary Ellen Gurrola
Andrea Gurrola		TIME COMPLETED:
02:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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. Two (2) clients were present during today's inspection.

Facility tour conducted. Facility observed to be clean and odor free. Adequate seating and lighting observed in both the living room, and dining room. Client bedrooms have all required accommodations. Client bathroom toured, LPA measured water temperature 111 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 the kitchen. 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 10/01/2023 according to facility records.

Outside of facility toured. All exits observed to be free of obstruction.

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

No deficiencies cited during today's visit. Exit interview conducted and a copy of report provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
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)
Page: 1 of 1