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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 471372608
Report Date: 03/10/2025
Date Signed: 03/10/2025 03:32:27 PM

Document Has Been Signed on 03/10/2025 03:32 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:BARKERS RESIDENTIAL CAREFACILITY NUMBER:
471372608
ADMINISTRATOR/
DIRECTOR:		SMALL, ERYKAHFACILITY TYPE:
735
ADDRESS:200 4TH STREETTELEPHONE:
(530) 598-7125
CITY:MONTAGUESTATE: CAZIP CODE:
96064
CAPACITY: 15CENSUS: 10DATE:
03/10/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:05 PM
MET WITH:Juanita Potts LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 3-10-25 Licensing Program Analyst LPA's Sarah Benson and Kayla Adkison met with Juanita Potts for a Health and Safety check.

The LPA's also met with Dan Bonham from Siskiyou County Mental Health.

Ten client files were copied and returned to the Licensee Juanita Potts.

LPA's Benson, Adkison and Licensee toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to eight (8) resident rooms, common areas, three (3) bathrooms, kitchen, storage areas and yard. Staff and resident interviews were performed.



An exit interview was conducted, no citations issued and a copy of the report was give to the Licensee Juanita Potts.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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