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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 471372608
Report Date: 12/18/2024
Date Signed: 04/10/2025 02:09:41 PM

Document Has Been Signed on 04/10/2025 02:09 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: 11DATE:
12/18/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Juanita Potts LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:27 AM
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An office meeting was held today, 12/18/2024 at 11:00AM, via Microsoft Teams to discuss the plans for the future of the facility.
The following Licensing staff were present:
Sacramento North Region Manager (RM) Alycia Rayner, Licensing program Manager (LPM) Lauren Crocker and Licensing Program Analyst (LPA) Sarah Benson.
The following facility representatives were present:
Licensee Juanita Potts, Administrator Erykah Timberlake-Small Licensee Juanita Potts, House Manager David Small and Amber Tulle.
The following staff from Siskiyou County Behavioral Health:
Assistant Administrator for Behavioral Health Shannon Clymer.
The following was discussed during today's meeting:
· The Licensee informed the department of the decision to sell the property.
· LPM Lauren Crocker inquired if the Licensee has a buyer. The House Manager David Small stated Dan Bonham with Behavior Health has been in communication regarding potential buyers.
· LPM requested a plan to be submitted of how the Licensee will move forward including the timeline for this process. LPM stated the importance of communicating with your LPA during this time. The LMP also outlined the Departments expectations in regards to the sale of the property and the licensure of the buyers of the property via the application process and continued responsibility of maintaining the required care and supervision of the residents in care until the application process is complete.
· RM Alycia Rayner stated there are many steps involved in a transfer of ownership. The first step is to notify the responsible parties of the plan to sell. RM stated the clients and their responsible parties need to be notified and a copy put in their file and sent to Licensing. RM assured that an email with the steps that are expected will be disseminated through the LPA to all parties involved in running the facility. RM highlighted the importance of constant communication with the facility’s LPA through every step of the transition.
Continued on LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Sarah Benson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BARKERS RESIDENTIAL CARE
FACILITY NUMBER: 471372608
VISIT DATE: 12/18/2024
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  • Assistant Administrator for Behavioral Health Shannon Clymer presented another provider that has offered to assist in the transition.

LPA will follow-up with Licensee to ensure all questions are answered. LPA will set up a team’s meeting when a potential buy has been submitted 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: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC809 (FAS) - (06/04)
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