455001096-10-4-2024-59-AS-SBEN-D9QUAB-20241004152429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455001096
Report Date: 10/04/2024
Date Signed: 10/04/2024 03:24:36 PM

Document Has Been Signed on 10/04/2024 03:24 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	HAWKINS RESIDENTIAL FACILITIES		FACILITY NUMBER:	455001096
ADMINISTRATOR/ DIRECTOR:	HAWKINS, NATALIE		FACILITY TYPE:	735
ADDRESS:	2512 PENELOPE STREET		TELEPHONE:	(530) 243-8082
CITY:	REDDING	STATE: CA	ZIP CODE:	96001
CAPACITY: 6		CENSUS: 6	DATE:	10/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:36 PM
MET WITH:	Margo Rudy Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:37 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 10/04/2024 01:36 PM Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Margo Rudy acting for Natalie Hawkins (cert #6025897735 exp.3-21-25) and explained the purpose of the visit. Administrator certificate is current.

LPA Benson and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to five (5) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medications were also reviewed. Medication is locked in a locked closet.

The common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair. There is an odor as I walked in the home and more so in the back of the house where the dogs are kept. The kitchen was clean and in good repair. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food.
The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. There is a schedule of activities planned for the clients. All required postings are displayed within the facility.
No pools/bodies of water are on the premises. No firearms are on premises. The last disaster drill was conducted and documented on 09-21-24, the facility has been conducting drills every 3 months.

The following deficiencies were observed (See LIC 809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, a copy of the report, and appeal rights provided to administrator?

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

Document Has Been Signed on 10/04/2024 03:24 PM - It Cannot Be Edited

Created By: Sarah Benson On 10/04/2024 at 03:16 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HAWKINS RESIDENTIAL FACILITIES	FACILITY NUMBER: 455001096
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and smell, the licensee did not comply with the section cited above in the house looks clean but has smells which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/04/2024
	Plan of Correction
1 2 3 4	Staff will have the carpets cleaned. Staff will notify LPA when the carpets have been cleaned.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Lauren Crocker

LICENSING EVALUATOR NAME:

Sarah Benson

LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2