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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525000407
Report Date: 11/10/2022
Date Signed: 11/10/2022 10:05:59 AM

Document Has Been Signed on 11/10/2022 10:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:PRS - BAKER HOUSEFACILITY NUMBER:
525000407
ADMINISTRATOR:GATES, MARYFACILITY TYPE:
735
ADDRESS:14062 BAKER RDTELEPHONE:
(530) 529-9339
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 6CENSUS: 4DATE:
11/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Laurie Schlottman - administratorTIME COMPLETED:
10:15 AM
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11/10/2022 9:45 AM Licensing Program Analysts (LPAs) Rebecca Knight and Shannon Diegoruelas arrived at the facility unannounced to conduct an unannounced case management visit. LPAs met with administrator Laurie Schlottman. The purpose of the visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES. Prior to initiating the complaint investigation LPAs completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPAs ensured they applied hand sanitizer when entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. Additionally, LPAs were screened by facility staff.

LPAs met with Administrator and stated the purpose of visit. Facility understands this is an Immediate Exclusion effective 11/10/2022 and S1 is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility.

Exit interview conducted, a copy of this report provided on this date. A signature on these forms acknowledges receipt of these forms.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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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