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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547200879
Report Date: 10/04/2023
Date Signed: 10/04/2023 06:43:08 PM

Document Has Been Signed on 10/04/2023 06:43 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:KENYON HOME #1, THEFACILITY NUMBER:
547200879
ADMINISTRATOR:KENYON, DEBRAFACILITY TYPE:
735
ADDRESS:2511 N. LIBERTY CT.TELEPHONE:
(559) 738-9298
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 4DATE:
10/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Licensee/Administrator (L/A) Debra KenyonTIME COMPLETED:
06:30 PM
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An unannounced Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Licensee/Administrator (L/A) Debra Kenyon.

Physical plant toured. 2 day supply of perishable & 7 day supply of Non perishable food on the premises. Dining & living rooms have required seating & lighting. Client bedrooms toured. Bedrooms have required furnishings & lighting. Bathroom used by client(s) toured. Bathroom appeared to be clean with no unpleasant odors. Locked storage observed for cleaning products & other hazardous items making them inaccessible to clients. Smoke detectors operational. Interior & exterior passageways observed to be clear with no obstructions.
Facility appeared to be clean with no unpleasant odors. Clients well groomed.
Medications observed to be locked & to be organized.

Client & staff records to be reviewed at a future date.

Exit interview held with L/A. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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