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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209345
Report Date: 08/12/2024
Date Signed: 08/12/2024 12:05:54 PM

Document Has Been Signed on 08/12/2024 12:05 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:PURPOSEFUL RESIDENTIAL CARE: HAWK PLACEFACILITY NUMBER:
157209345
ADMINISTRATOR/
DIRECTOR:		VICKERS, ADONICAFACILITY TYPE:
735
ADDRESS:600 HAWK SPRINGS DRIVETELEPHONE:
(661) 695-6002
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 0DATE:
08/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:Adonica VickersTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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On 8/12/2024 , Licensing Program Analyst (LPA) M. Medina conducted an Annual/Required visit. LPA met with Licensee/Administrator, Adonica Vickers to conduct facility tour.

Currently, there are no residents in care. Facility was licensed in October 2023 and has no had any residents in placement. Facility tour conducted. Residents bedrooms are fully furnished with required accommodations. Facility observed to be clean and odor free. Adequate seating and lighting observed in both the living room, and dining room. Client bathrooms toured, fixtures observed operational, water temperature measured at 111 degrees F. Kitchen toured, LPA observed a 7-day supply of non-perishable food. Medications and sharps will be locked and secured in closet hallway. Cleaning supplies observed to be locked and secured in garage.

Smoke detectors and carbon monoxide observed to be operational during today's inspection. Fire extinguisher present with a purchase date of 10/10/2023.

Outside of facility toured. Pool is surrounded by gate that is locked, secured, and inaccessible to residents. All exits open free of obstruction, no hazards observed.


No deficiencies cited during today's visit. Exit interview conducted and a copy of report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2024
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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