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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 471372608
Report Date: 12/02/2024
Date Signed: 12/02/2024 02:40:55 PM

Document Has Been Signed on 12/02/2024 02:40 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:
12/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Administrator Erykah Smith and House Managers David.TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 12-2-24 Licensing Program Analyst LPA Sarah Benson arrived at the facility and met with Administrator Erykah Smith and House Managers David to open a case management conserving the records requested by auditing.
Documents were not reviewed due to staff not responding for the request of documents.

On 6-20-24 an Audits Solvency request was opened for Barker’s facility. The Audits department presented an engagement letter on 8-19-24 requesting documents Bank statements, utility bills, loan statements and most other documents that are typically readily available with a due date of 9-19-24. The Auditing department sent a follow up email on 9-24-24 as a reminder of the requested documents. Auditing reported sending past due notices on 9-25-24 and 10-10-24. Auditing reported they have not received a response or request of an extension. On 10-22-24 LPA Benson performed the yearly annual inspection and offered to return the requested auditing paperwork. Staff stated they have not completed the paperwork. LPA Benson reported that auditing offered an extension of 5 days from 10-22-24.

On 10-28-24 the administrator emailed auditing stating “we are completely stunned by all the information that is needed.” The administrator stated, “I do know, that taxes haven't been done in a few years.” The administrator reported, we will do our best on answering and filling out this form accurately and to the best of our ability. On 11-8-24, the requested paperwork and reports have not been turned into auditing.

The facility is not in compliance.



Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D.

Appeal rights were provided. An exit interview was conducted. A copy of the report was provided to Administrator Erykah Smith and House Managers David.
Completed on LIC9099-D
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2

Created By: Sarah Benson On 12/02/2024 at 10:59 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BARKERS RESIDENTIAL CARE
FACILITY NUMBER: 471372608

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2025
Section Cited
CCR
80062(a)(1)

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(a) The licensee shall meet the following financial requirements: (3) Submission of financial reports as required upon the written request of the department or licensing agency. This requirement is not met as evidenced by:
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The staff with sumbit requested financial reports to LPA Benson.
The staff will pay the annual fees by 12-27-24.
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 The staff did not submit requested financial records.
This poses an immediate health, welfare and safety hazard to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lauren Crocker
LICENSING EVALUATOR NAME:Sarah Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/02/2024


LIC809 (FAS) - (06/04)
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