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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209345
Report Date: 10/11/2023
Date Signed: 10/16/2023 10:36:34 AM

Document Has Been Signed on 10/16/2023 10:36 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:PURPOSEFUL RESIDENTIAL CARE: HAWK PLACEFACILITY NUMBER:
157209345
ADMINISTRATOR:VICKERS, ADONICAFACILITY TYPE:
735
ADDRESS:600 HAWK SPRINGS DRIVETELEPHONE:
(661) 695-6002
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 0DATE:
10/11/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Adonica VickersTIME COMPLETED:
10:51 AM
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On 10/11/23, Licensing Program Analyst (LPA) M. Medina conducted a subsequent announced Pre-licensing inspection. LPA met with Licensee, Adonica Vickers. LPA toured the facility with Licensee.

The following items have been completed:

1) All personal items were removed from home

2) All yard tools are locked and secured

3) All items near backyard exit have been removed.

Component III was conducted with Licensee.

LPA found that applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.



Exit interview conducted. A copy of this report was provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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