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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547200879
Report Date: 07/19/2024
Date Signed: 07/19/2024 07:58:55 PM

Document Has Been Signed on 07/19/2024 07:58 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/
DIRECTOR:		KENYON, DEBRAFACILITY TYPE:
735
ADDRESS:2511 N. LIBERTY CT.TELEPHONE:
(559) 738-9298
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 4DATE:
07/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee/Administrator (L/A) Debra KenyonTIME VISIT/
INSPECTION COMPLETED:
06:30 PM
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An unannounced Annual visit was conducted by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Licensee/Administrator (L/A) Debra Kenyon. LPA greeted L/A, stated purpose of visit, & was allowed entry.

Physical plant toured. Kitchen has 2 day supply of perishable & 7 day supply of Non-perishable food on the premises. Dining & living rooms have required seating & lighting. Client bedrooms have required furnishings & lighting. Client 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.

Facility appeared to be clean with no unpleasant odors. Clients well groomed.
Medications observed to be locked & to be organized. First aid kit complete.
Resident files secured. Interior & exterior passageways observed to be clear with no obstructions.

Outside & garage toured. No hazards observed.

Exit interview conducted L/A. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2024
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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