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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209265
Report Date: 03/28/2023
Date Signed: 03/28/2023 07:41:44 PM

Document Has Been Signed on 03/28/2023 07:41 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 #2, THEFACILITY NUMBER:
547209265
ADMINISTRATOR:KENYON, DEBRAFACILITY TYPE:
735
ADDRESS:2541 E MARY AVETELEPHONE:
(559) 303-2640
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 6CENSUS: 6DATE:
03/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Debra Kenyon, Applicant (L); Steve Valverde, House Manager (HM);TIME COMPLETED:
08:00 PM
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
An Pre-Licensing visit was conducted on the time & date by Licensing Program Manager (LPA) K. McClurg. LPM met with Debra Kenyon, Applicant (L) & Steve Valverde, House Manager (HM).

Facility phone: (559) 802-3305. Physical plant toured. Regulations reviewed. Facility is clean & in good repair. Interior & exterior passageways free of obstructions. Items that could pose a danger, such as disinfectants, cleaning solutions, etc., are inaccessible. Sufficient lighting & furnishings in dining, living, & resident bedrooms. Locked centralized storage area for medications. First aid kit complete. Hot water tested & measured at 120 degrees F in front hall bath & measured at 112 degrees F in back hall bath . Physical plant is consistent with the facility sketch/floor plan. Fire extinguisher service date: 12/19/2023. Smoke & carbon monoxide operational.

A Component III was conducted.

Pre-Licensing is complete and this facility has no deficiencies

Exit interview conducted with L & HM. Report provided at time of visit.

NOTE: L provided updated documents to change appointed Administrator with pending application. Information emailed to CAB LPA @ time of visit.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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 1