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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001803
Report Date: 11/28/2023
Date Signed: 11/28/2023 12:32:54 PM

Document Has Been Signed on 11/28/2023 12:32 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 FACILTIES - FILAREEFACILITY NUMBER:
455001803
ADMINISTRATOR:KINGSLEY, SHERRIEFACILITY TYPE:
735
ADDRESS:1672 FILAREE DRIVETELEPHONE:
(530) 221-2763
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 6CENSUS: 6DATE:
11/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Sherrie KingsleyTIME COMPLETED:
01:00 PM
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On 11/28/20230 Licensing Program Analyst (LPA) Ivan Avila arrived at the facility unannounced to conduct a 1-year annual inspection and met with Sherrie Kingsley and explained the purpose of the visit. LPA Avila and Administrator toured the facility together to ensure the health and safety of residents in care..
Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient supply of perishable and non-perishable food at the facility; Sharp objects are stored in locked cabinet. Hot water temperature measured at 120 degrees. Bedrooms: The LPA observed resident bedrooms furnished with at least one night stand, bed, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, and blankets. Bathrooms: The LPA observed the resident’s bathroom to be clean, and properly supplied. Residents have sufficient supplies for personal hygiene. Common Areas: These included the living, and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no fire arms on the premises. Pool area is surrounded by a five foot fence making it inaccessible to residents in care. Record Review: A review of facility files was initiated. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill. The LPA obtained Resident Roster, Staff Roster, and facility Sketch. The LPA reviewed four (4) staff, and four (4) resident files. All documents reviewed appeared complete and current. Medications: During the facility visit a medications review was initiated. Medications are centrally stored and locked in a cabinet inaccessible to residents in care; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiencies being cited. Exit interview conducted and copy of the report and provided to Sherrie Kingsley.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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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