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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209213
Report Date: 02/15/2022
Date Signed: 02/15/2022 01:03:06 PM

Document Has Been Signed on 02/15/2022 01:03 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:SHERRILL MORRIS CARE HOMESFACILITY NUMBER:
547209213
ADMINISTRATOR:MORRIS, TYLERFACILITY TYPE:
735
ADDRESS:1933 W. BRIAN AVETELEPHONE:
(559) 359-9214
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 0DATE:
02/15/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:34 AM
MET WITH:Sherrill MorrisTIME COMPLETED:
01:10 PM
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Licensing Program Analysts (LPA) M. Medina arrived to the facility announced to conduct the Pre-licensing inspection. LPA Medina met with Licensee Sherrill Morris. LPA toured facility inside and outside. The following items must be completed and/or prior to follow-up inspection.

1) Nine (9) windows require window covering
2) Laundry room exhaust fan needs to be secure
3) Laundry room light as exposed bulb socket
4) Water temperature measured at 125 degrees F.
5) Medication cabinet requires lock
6) Cabinet to secure chemicals and cleaning supplies requires lock
7) Exit gate from backyard requires hinge to self close

A fire extinguisher is present and has a service date of 11/17/21. Smoke detectors and carbon monoxide detector tested and observed operational during today's inspection.

Outside of the facility toured.

Facility temporary phone number is (559) 359-9214. Department to be notified when phone number updates

Licensee to contact LPA to conduct follow up inspection when items are completed.

Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed. Report was signed by Licensee during exit interview.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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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