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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001803
Report Date: 01/11/2023
Date Signed: 01/11/2023 03:42:10 PM

Document Has Been Signed on 01/11/2023 03:42 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:HAWKINS RESIDENTIAL FACILTIES - FILAREEFACILITY NUMBER:
455001803
ADMINISTRATOR:KINGSLEY, SHERRIEFACILITY TYPE:
735
ADDRESS:1672 FILAREE DRIVETELEPHONE:
(530) 221-2763
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 6CENSUS: 6DATE:
01/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Bobbie McDonaldTIME COMPLETED:
03:50 PM
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LPA Hiratsuka, conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wearing masks.

The front door opens to a very short hallway. To the right of the hallway is the dining area and kitchen. Past the dining area is a staff area. Behind the kitchen and through a doorway leads to a space that has the clothes washer and dryer, food storage, and two resident rooms. The main sitting area with a sliding door is in the rear of the facility. To the left of the entrance is a hallway that leads to three resident rooms and a full common bathroom. The largest of the resident rooms has a full private bathroom. The backyard has a pool that has a fence with a locked gate around it.

Two resident files were reviewed
Three staff files were reviewed.

Several topics were discussed.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2023
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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