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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209540
Report Date: 03/13/2025
Date Signed: 03/14/2025 08:40:24 AM

Document Has Been Signed on 03/14/2025 08:40 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:BLUE MORPHO ASSISTED LIVINGFACILITY NUMBER:
207209540
ADMINISTRATOR/
DIRECTOR:		GREEN, KAMERONFACILITY TYPE:
740
ADDRESS:1052 ARIANA ST WTELEPHONE:
(559) 285-0507
CITY:MADERASTATE: CAZIP CODE:
93636
CAPACITY: 6CENSUS: 0DATE:
03/13/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Kameron Green, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Rachel Bruce arrived at the facility to conduct the Pre-Licensing Inspection. LPA met with Administrator (AD) Kameron Green.
LPA began the tour by entering through the front door of the 5 bedroom/3 bathroom/1 story home. Interior common areas have adequate furnishings and lighting. Along with adequate lighting and a chair, all 5 client bedrooms have the required beds, night stands with drawers and closet space or chest of drawers. LPA verified there were adequate bed linens stored in hall closet.
Smoke and Carbon Monoxide detector combination alarms are located throughout and were observed to be in working order. LPA observed an adequate supply of towels. There will be a more adequate supply of personal hygiene and grooming products once there are residents and their needs are known. AD will ensure along with towels there will be a supply of paper towels available in the bathrooms. Hot water temperature in bathrooms met regulatory requirements. Non-Skid mats and grab bars were present in the showers.

Kitchen observed to have supply of dishes, plates, pots and pans, and utensils for 6. Food storage and preparation areas are clear and appropriate for food preparation. Cleaning supplies and chemicals are locked in the garage cabinet. Sharps/knives are located in a locked pantry/closet in the kitchen area. Appliances observed to be in working order. LPA did not observe a 7 day supply of non-perishable food, but AD understands the requirements once residents are in place. First aid kit contains all the required items. There were two fire extinguisher present with proof of purchase attached.
Washer and Dryer observed in the laundry room with additional storage space available in upper cabinets. Locked laundry detergent can be found with the chemicals in the garage.
Doors and passageways are unobstructed throughout the home. Outside of the facility toured. There is a covered seating area and a self-latching gate found to be working properly. The home does not have a pool.

An exit interview was conducted as well as a COMP III power point presentation. A copy of this report will be emailed to AD. AD will notify CCL when the first resident is in place which will trigger a post licensing inspection.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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