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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 471372608
Report Date: 02/14/2024
Date Signed: 02/14/2024 03:09:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2023 and conducted by Evaluator Sarah Benson
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20231107164442
FACILITY NAME:BARKERS RESIDENTIAL CAREFACILITY NUMBER:
471372608
ADMINISTRATOR:DAUSEL, CYNDIFACILITY TYPE:
735
ADDRESS:200 4TH STREETTELEPHONE:
(530) 905-1409
CITY:MONTAGUESTATE: CAZIP CODE:
96064
CAPACITY:15CENSUS: 11DATE:
02/14/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Erykah Timberlake-Small House ManagerTIME COMPLETED:
03:44 PM
ALLEGATION(S):
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Staff do not treat residents in care with respect.
INVESTIGATION FINDINGS:
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2/14/2024 1:30 PM Licensing Program Analysts (LPA) Sarah Benson made an unannounced visit to the facility and met with Administrator Erykah Timberlake-Small to deliver final findings regarding a complaint that was received on 11/07/23.

LPA interviewed the administrator, 1 staff and 7 client during the visit. LPA requested the following documents during the visit, admission agreements, physician reports and medical records.


See LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 59-AS-20231107164442
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 02/14/2024
NARRATIVE
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During the interview process most of the residents report they are treated with respect. Overall, the residents indicated that they were treated with care and respect, that staff were helpful. During staff interviews a staff reported, I treat the residents like I would like to be treated and that staff gets along well with the residents.

Although the above allegations mentioned may have happened, or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, the findings are Unsubstantiated.

Exit interview conducted, a copy of the report, and appeal rights provided to administrator

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2