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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455003000
Report Date: 02/22/2023
Date Signed: 02/22/2023 11:00:21 AM

Document Has Been Signed on 02/22/2023 11:00 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-NEMA CRISFACILITY NUMBER:
455003000
ADMINISTRATOR:POTTER, JEREMYFACILITY TYPE:
735
ADDRESS:1078 PINELAND DRTELEPHONE:
(530) 209-8364
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 4CENSUS: 0DATE:
02/22/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Jeremy Potter - licenseeTIME COMPLETED:
11:00 AM
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02/22/2023 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct a Pre-Licensing visit for a re-location application. Prior to initiating the annual inspection, LPA completed 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: N95 mask, gloves. LPA met with licensee Jeremy Potter and explained the purpose of the visit.

Comp 3 was waived by licensee as they are currently licensed for four other facilities. Licensee plans to close one existing facility and will be relocating all clients into the new location.

The fire marshal has approved the fire safety inspection request. The facility is licensed for a total capacity of 4 ambulatory clients.

The inside of the facility was observed to be in good condition and repair. The facility has four (4) bedrooms, two (2) bathrooms, kitchen, dining room, living room, office, laundry room, and garage. Once the new location has been approved the furniture from the prior location will be moved to the new location.


Continued on LIC809-C
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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-NEMA CRIS
FACILITY NUMBER: 455003000
VISIT DATE: 02/22/2023
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Food storage meets Title 22 regulation requirements. Plates, utensils, pots, and pans will be moved over from the previous location. Dishwasher, stove, microwave and refrigerator were all present and working.

The facility has one fully charged fire extinguisher which was inspected by the fire marshal. LPA observed smoke alarms and carbon monoxide detectors fully functioning.

The bedrooms will be furnished when the other facility closes. Each bedroom has ample storage. The facility has a linen closet where sheets, pillowcases, towels and face cloths will be stored. Bathrooms were observed to be in good repair.



Medications are to be stored in a locked closet. Facility client files will also be stored in this location.

Storage and lighting are adequate in the home. Cleaning supplies and toxins are to be locked up in a cabinet in the laundry room. Also locked in the laundry room are knives. New washer and dryer will be delivered and installed for use in laundry room before clients move in.

The back yard has a nice, patio and lawn area. The licensee will move the outdoor furniture from the facility that is closing for clients to use.

LPA reminded licensee that they need to prepare the facility for Covid-19 restrictions before they can move residents into the facility.

The applicants have passed the pre-licensing portion of the application process. LPA will contact the Central Application Bureau.

No deficiencies according to CCR Title 22, Division 6. Exit Interview and copy of report was provided to the licensee.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023
LIC809 (FAS) - (06/04)
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