Facility Evaluation Report

Licensing Program Analyst Katie Brown conducted a Case Management – Health Checks. LPA met with and explained the reason for the visit with Licensee/Administrator (AD) Mary Ellen Gurrola.

The purpose of the visit is to verify the address of the facility. There are two homes on the property of 287 Teapot Dome. During this visit, LPA verified the following with AD:

1. 287 B1 Teapot Dome is the private residence of AD..

2. 287 B2 is the address of the facility.

AD has agreed to update the numbers on the front of both homes.

There were no citations issued during the visit.

An exit interview was conducted and a copy of this report was left with , whose signature confirms receipt of these documents.