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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209518
Report Date: 02/26/2025
Date Signed: 02/26/2025 12:02:52 PM

Document Has Been Signed on 02/26/2025 12:02 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:EBONY HOME 2FACILITY NUMBER:
547209518
ADMINISTRATOR/
DIRECTOR:		THOMPSON, JENNIFERFACILITY TYPE:
735
ADDRESS:627 W. WILLOW OAK AVETELEPHONE:
(559) 310-0271
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 0DATE:
02/26/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Jennifer ThompsonTIME VISIT/
INSPECTION COMPLETED:
12:41 PM
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A Prelicensing visit was conducted on the date & during the times indicated above by Licensing Program Analyst (LPA) L. Xiong. LPA met with Administrator, Jennifer Thompson.

Physical plant toured. This facility has no pool, dining rooms sufficiently furnished with adequate lighting. Kitchen toured. Two (2) day supply of perishable & 7 day supply of non-perishable food on the premises. Resident rooms toured. Rooms sufficiently furnished with adequate lighting. Resident bathrooms toured. Hot water measured at 120 degrees. Interior & exterior passageway observed to be free of obstructions. Facility has a locked medication room. Outside area toured. No deficiency observed.

No outstanding issues. Component III conducted during this visit.
Exit interview conducted with Administrator.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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