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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209178
Report Date: 06/21/2022
Date Signed: 06/21/2022 02:46:02 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
06/10/2022 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220610150816
FACILITY NAME:PURPOSEFUL RESIDENTIAL CARE: HASWELL PLACEFACILITY NUMBER:
157209178
ADMINISTRATOR:VICKERS, ADONICAFACILITY TYPE:
735
ADDRESS:503 HASWELL STREETTELEPHONE:
(661) 829-7125
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 1DATE:
06/21/2022
UNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Adonica VickersTIME COMPLETED:
03:07 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is verbally and physically abusive
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/21/2022, Licensing Program Analyst (LPA) M. Medina conducted a subsequent visit to facility to investigate complaint. LPA identified herself and discussed the purpose of visit with Administrator, Adonica Vickers.

LPA conducted interviews, and reviewed facility video footage during complaint investigation. Based on interviews, and observation of video, there is insufficient evidence that allegations occurred.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. No deficiencies cited.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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