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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167206688
Report Date: 04/05/2024
Date Signed: 04/05/2024 10:04:56 AM

Document Has Been Signed on 04/05/2024 10:04 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:KINGS REHABILITATION CENTER, INC.-DTACFACILITY NUMBER:
167206688
ADMINISTRATOR/
DIRECTOR:		ACOSTA, SUSANFACILITY TYPE:
775
ADDRESS:488 E. HANFORD ARMONA RDTELEPHONE:
(559) 583-5051
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 120CENSUS: 64DATE:
04/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Program Manager Stephanie SanchezTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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
Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Program Director Stephanie Sanchez. LPA disclosed the purpose of the inspection and was granted entry into the facility by Program Director Stephanie Sanchez.

A tour of the facility was conducted with Program Director Stephanie Sanchez. The facility was set at 74 F temperature and free of passageway obstructions inside and outside. The water temperature was measured at 118.4 F.

Facility serves breakfast and lunch. Clients were observed to be eating eggs, a banana and a bisquit with milk for breakfast.

Kitchen was toured. Cleaning supplies were in a locked storage room. Smoke detectors and carbon monoxide detectors were checked and operating. Facility is wired with sprinkler system. Fire extinguishers were charged and had service dates of 04/05/24. Fire drill was last completed on 03/06/24.

Client and staff records were reviewed. Client medications were checked. Current first aid and CPR were on file for staff.

Facility will submit current disaster plan.

An exit interview was conducted with the Program Manager and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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 2