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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206564
Report Date: 03/08/2023
Date Signed: 03/09/2023 11:19:59 AM


Document Has Been Signed on 03/09/2023 11:19 AM - 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:SUMMIT HILLS IFACILITY NUMBER:
157206564
ADMINISTRATOR:SAVANNAH MATTHEWSFACILITY TYPE:
740
ADDRESS:4614 UPLAND POINT DRIVETELEPHONE:
(661) 872-2160
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:6CENSUS: 0DATE:
03/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Administrator Kayla WelkerTIME COMPLETED:
11:37 AM
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Licensing Program Analyst (LPA) Darius Williams conducted an announced visit in response to facility closure. LPA Williams met with Administrator, Kayla Welker.

LPA Williams toured the facility and no clients were in care.

LPA Williams received the facility license with statement identifying forfeiture of the license.

LPA Williams conducted an exit interview and a copy of this report will be provided via e-mail.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023
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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