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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547209265
Report Date: 04/12/2024
Date Signed: 04/12/2024 05:04:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/29/2023 and conducted by Evaluator Kelly J. McClurg
COMPLAINT CONTROL NUMBER: 24-AS-20230929093137
FACILITY NAME:KENYON HOME #2, THEFACILITY NUMBER:
547209265
ADMINISTRATOR:KENYON, DEBRAFACILITY TYPE:
735
ADDRESS:2541 E MARY AVETELEPHONE:
(559) 303-2640
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:6CENSUS: 5DATE:
04/12/2024
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Assistant Administrator/House Manager (AA) Steve ValverdeTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff slapped client in care
Staff did not treat resident with dignity or respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An unannounced Complaint visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Assistant Administrator/House Manager (AA) Steve Valverde & stated purpose of visit.

Facility training regarding Personal Rights & reporting requirements. Facility Policy & Procedures discussed. Client 1 (C1) not longer at this facility. Prior to Xmas 2023, C1 went to hospital & then was moved to a higher level of care. C1 had begun to display confusion & disorientation akin to some forms of dementia.

The Department has investigated the above allegations & found them to be Unsubstantiated.

Exit interview conducted with AA. Report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 1