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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 471372608
Report Date: 01/29/2025
Date Signed: 01/29/2025 12:39:06 PM

Document Has Been Signed on 01/29/2025 12:39 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) 598-7125
CITY:MONTAGUESTATE: CAZIP CODE:
96064
CAPACITY: 15CENSUS: 10DATE:
01/29/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licensee Juanita Potts and Administrator Erykah Smith TIME VISIT/
INSPECTION COMPLETED:
01:08 PM
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On 1-29-25 at 11:30am Licensing Program Analyst LPA Sarah Benson arrived at the facility and met with Administrator Erykah Smith.

The purpose of the visit was to interview two residents for complaint 59-AS-20250109132653 and have staff sign office meeting notes. During the interview R1 stated his roommate was served an eviction notice. The administrator stated the client was served an eviction notice for smoking in the living room. LPA Benson inquired if regulation 85068.5(e) a written report of eviction processed shall be sent to the licensing agency within five days of the eviction. The Administrator stated they will re-issue the eviction notice and notify licensing with required reports.

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: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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