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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 471372608
Report Date: 04/05/2024
Date Signed: 04/05/2024 11:29:39 AM

Substantiated


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
03/27/2024 and conducted by Evaluator Sarah Benson
COMPLAINT CONTROL NUMBER: 59-AS-20240327160846
FACILITY NAME:BARKERS RESIDENTIAL CAREFACILITY NUMBER:
471372608
ADMINISTRATOR:CRANE, SANDEEFACILITY TYPE:
735
ADDRESS:200 4TH STREETTELEPHONE:
(530) 905-1409
CITY:MONTAGUESTATE: CAZIP CODE:
96064
CAPACITY:15CENSUS: 11DATE:
04/05/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:House Manager David Small TIME COMPLETED:
12:02 PM
ALLEGATION(S):
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Facility is malodorous.
Facility is unclean.
INVESTIGATION FINDINGS:
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04/04/24 1:00 PM Licensing Program Analyst (LPA) Sarah Benson, conducted an unannounced visit and met with administrator David Small House Manager. The purpose of this visit was to open a complaint investigation.

During today's visit the facility was toured, records were reviewed and interviews were performed.
LPA interview administrator Sandee Crane. LPA observed couches with food and dirt stains, kittens under one couch, floors with dirt and pebbles and food wrapers. LPA observered and smelled a unclean oder.

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 House Manager David Small and a copy emailed to administrator.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
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 3
Control Number 59-AS-20240327160846
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2024
Section Cited
CCR
80087(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients... This requirement is not met as evidenced by: LPA observed couches with food and dirt stains, kittens under one couch, floors with dirt and pebbles and food wrapers.
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Staff will steam clean carpet and couches.
Staff will replace couches as needed.
Staff will clean under and behind couches.
Staff will submit cleaning responsibilities of residents and staff.
Staff will email LPA when complete.
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 Based on record review, interviews of staff persons and residents, the licensee did not implement a plan to ensure the facility is clean, safe and sanitary.
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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.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024
LIC9099 (FAS) - (06/04)
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