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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 471372608
Report Date: 12/05/2024
Date Signed: 04/10/2025 02:11:15 PM

Document Has Been Signed on 04/10/2025 02:11 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: 11DATE:
12/05/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Licensee Juanita Potts, Administrator Erykah Timberlake Small.TIME VISIT/
INSPECTION COMPLETED:
03:32 PM
NARRATIVE
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An office meeting was held today, 12/05/2024, via Microsoft Teams to address the topics listed below.

The following Licensing staff were present:
Licensing Program Manager (LPM) Troy Ordonez, LPM Lauren Crocker, and Licensing Program Analyst (LPA) Sarah Benson.

The following facility representatives present:
Licensee Juanita Potts, Administrator Erykah Timberlake-Small, House Managers David Small, Jennifer Potts, and Amber Tuller.

The following topics were covered during today's meeting:
· The Licensee informed the department that she wants to close the facility. The house managers also informed that they will be giving 30-day notices to the residents and that they would be moving.
· LPM Crocker explained that a 60-day notice would be required to close the facility and that there are options the licensee can consider that would not displace the residents in care.
· There was a discussion in regard to the outstanding corrections from the recent facility annual inspection.
· The licensee was encouraged to take a few days to consider her options and consult with her support system and a follow up meeting will be scheduled for next week to discuss next steps..

LPA will follow-up with Licensee to ensure all questions are answered. LPA will set up a team’s meeting next week with CCLD representatives, Siskiyou County Mental Health Program Director, Licensee and those who accompany the licensee.

An exit interview was conducted, and a copy of this report will be provided to the facility via email. A copy will be signed and returned to CCLD. The signature of the Licensee on this form acknowledges receipt of this document.
NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Sarah Benson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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