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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208854
Report Date: 01/04/2024
Date Signed: 01/04/2024 03:42:10 PM

Document Has Been Signed on 01/04/2024 03:42 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:HOUGHTON HOMEFACILITY NUMBER:
157208854
ADMINISTRATOR:SAYSON, SHANNONFACILITY TYPE:
735
ADDRESS:6444 HOUGHTON RDTELEPHONE:
(661) 827-8025
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 4CENSUS: 4DATE:
01/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Program Supervisor Lereese DelouthTIME COMPLETED:
01:00 PM
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Licensing Program Analyst LPA Shawna Doucette arrived at the facility unannounced to conduct a Case Management regarding an incident which occurred on 12/10/23.

LPA interviewed staff regarding an accusation of a physical altercation between staff and client. LPA requested copies of facility's internal investigation which will be emailed to LPA by 1/12/24. LPA interviewed staff and C1.

After internal investigation is reviewed, LPA will return to facility if needed.

An exit interview was conducted and a copy of the report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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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