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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002740
Report Date: 02/08/2023
Date Signed: 02/08/2023 11:24:15 AM

Document Has Been Signed on 02/08/2023 11:24 AM - 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:JD RESIDENTIAL SERVICES, INC- BILLY JEANFACILITY NUMBER:
455002740
ADMINISTRATOR:POTTER, JEREMYFACILITY TYPE:
735
ADDRESS:20308 BILLY JEAN LNTELEPHONE:
(530) 224-1552
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 4CENSUS: DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jeremy Potter - administratorTIME COMPLETED:
11:20 AM
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02/08/2023 10:20 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with house manager Autumn Flashner, admniistrator Domenique Potter and licensee Jeremy Potter and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask, gloves.

LPA Knight and Ms. Flashner toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to:four (4) client rooms, common areas, bathrooms, dining room, and storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Knight, and Mr. Potter completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report was provided to administrator Jeremy Potter.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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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