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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209213
Report Date: 02/28/2022
Date Signed: 02/28/2022 05:20:47 PM

Document Has Been Signed on 02/28/2022 05:20 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:
02/28/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:14 PM
MET WITH:Sherrill MorrisTIME COMPLETED:
04:15 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.

LPA toured facility. Common rooms and bedrooms have adequate lighting. The following items have been completed

1) All windows have screens
2) Laundry room exhaust fan is secure
3) Laundry room light has secure covering
4) Water temperature measured at 108.9 degrees F.
5) Medication cabinet is locked and secured
6) Cabinets for chemicals and cleaning supplies are locked and secured
7) Exit gate from backyard opens and closes without obstruction

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. No hazards observed.

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

Exit interview was conducted. I have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2022
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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