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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 471372608
Report Date: 10/22/2024
Date Signed: 10/22/2024 05:06:00 PM

Document Has Been Signed on 10/22/2024 05:06 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:BARKERS RESIDENTIAL CAREFACILITY NUMBER:
471372608
ADMINISTRATOR/
DIRECTOR:		CRANE, SANDEEFACILITY TYPE:
735
ADDRESS:200 4TH STREETTELEPHONE:
(530) 905-1409
CITY:MONTAGUESTATE: CAZIP CODE:
96064
CAPACITY: 15CENSUS: DATE:
10/22/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:David and Erykah Small TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 10-22-24 Licensing Program Analyst LPA Sarah Benson arrived unannounced at the facility and met with David Small and Erykah Timberlake Small.

LPA Benson and Administrator discuss the following topics, TSP report, updated facility map, new administrator paperwork, updated Designation of Facility Responsibility and a five day extension for auditing.

TSP report: Administrator stated the TSP investigation was really nice and helpful. The Administrator stated they have bought binders for the files but have not completed yet. Administrator stated they made a cleaning list for staff but not scheduled of duties yet.

Facility map: Administrator reported they forgot about updating the facility map and will contact the fire department.

New Administrator: LPA Benson checked status of Administrator on 10-22-24 and could find no status for Erykah Timberlake Smith. Administrator reported they received the administration packet back because they had overpaid. The administrator returned the correct amount with the packed 7-24, the check was cashed 8-24.

Designation of Facility Responsibility: Administrator stated they will update the designation of facility responsibilities and return to LPA on 10-29-24

Five day extension for auditing: Administrator stated they don't have the paperwork auditing requested, but they will complete required documents and send to auditing by 10-26-24.

LPA Benson performed exit interview and gave a copy of the report to Administrator.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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