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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455001096
Report Date: 05/08/2025
Date Signed: 05/08/2025 03:07:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2025 and conducted by Evaluator Sarah Benson
COMPLAINT CONTROL NUMBER: 59-AS-20250505124446
FACILITY NAME:HAWKINS RESIDENTIAL FACILITIESFACILITY NUMBER:
455001096
ADMINISTRATOR:RUDY, MARGOFACILITY TYPE:
735
ADDRESS:2512 PENELOPE STREETTELEPHONE:
(530) 243-8082
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:6CENSUS: 6DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Margo Rudy AdministratorTIME COMPLETED:
03:14 PM
ALLEGATION(S):
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Staff did not ensure the facility was kept free of mold.
INVESTIGATION FINDINGS:
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05/08/2025 at 2:00 PM Licensing Program Analyst (LPA) Sarah Benson, conducted an unannounced visit and met with Administrator Margo Rudy. The purpose of this visit was to open a complaint investigation. During today's visit the facility was toured and interviews performed.

LPA Benson requested the following documents during the visit: incident reports and repair records. LPA Benson took pictures of walls with mold.



Deficiencies cited. Exit interview conducted and a copy of the report was provided to the Administrator.
The above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D.
Report continued on LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 59-AS-20250505124446
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HAWKINS RESIDENTIAL FACILITIES
FACILITY NUMBER: 455001096
VISIT DATE: 05/08/2025
NARRATIVE
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On 5-8-25 Licensing Program Analyst LPA Sarah Benson interviewed the Administrator Margo Rudy.

When asked if the facility has a problem with mold, the Administrator stated yes, we had a pipe burst in the master bathroom behind the toilet about 11-8-23. Staff stated we had the repair completed by contracted plumbing, painting and heating and air contractors. Staff stated the pipes were repaired and the dry wall replaced and painted. Staff stated we have not had a problem with mold since the repair.

The staff stated in the last six weeks the mold has reappeared. LPA Benson ask if any contractors have been contacted to repair, and staff stated no.

LPA Benson observed mold in the bathroom on three out of four walls. LPA Benson observed the bathroom fan is not working. Pictures of the mold are included with report.

LPA Benson inquired if incident reports have been completed for the mold. Staff stated no.

The facility has mold the allegation is substantiated.

Based on investigation observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D.

Appeal Rights were explained and provided to the facility representative listed above and an exit interview was conducted. If any of the cited deficiencies are not corrected by the noted due date, civil penalties may be assessed.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20250505124446
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HAWKINS RESIDENTIAL FACILITIES
FACILITY NUMBER: 455001096
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2025
Section Cited
CCR
80087(a)
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80087(a) Buildings and Grounds. The facility shall be kept clean, sanitary and in good repair at all times.
LPA observed in master bathroom mold on three out of four walls.
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Administrator will hire contractors to repair/clean mold in master bathroom.
Administrator will have the fan repaired.
Administrator will submit incident reports when necessary.
Administrator will notify LPA with copies of reports or repairs when complete.
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This requirement was not met as evidenced by: Based on interviews and review of records, the licensee/administrator has mold in the master bathroom. The licensee has not made repaires as required.
This is a potential hazard to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3