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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525000407
Report Date: 08/13/2024
Date Signed: 08/13/2024 02:33:05 PM

Document Has Been Signed on 08/13/2024 02:33 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:PRS - BAKER HOUSEFACILITY NUMBER:
525000407
ADMINISTRATOR/
DIRECTOR:		PUCKETT, CHASEFACILITY TYPE:
735
ADDRESS:14062 BAKER RDTELEPHONE:
(530) 529-9339
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 6CENSUS: 4DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Chase Puckett - administratorTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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08/13/2024 09:30 AM Licensing Program Analysts (LPAs) Rebecca Knight and Farhaan Sarangi arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrators Chase Puckett and Laurie Schlottman and explained the purpose of the visit.

LPAs and the administrators toured the facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to four (4) client rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. Medications were reviewed. Medication is locked in a cabinet. All employees requiring background checks are cleared. Administrator certificate is current.

There is a schedule of recreational activities planned for the clients. Bedding, linens, and towels for clients were observed and found to be clean and in good repair.

The facility was observed to be at a comfortable temperature. Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Fire extinguishers fully charged and were inspected in July 2024. Smoke detectors are all operational. No pools/bodies of water are on premises. Last disaster drill was conducted in June 2024 which was a wild fire drill, the facility has been conducting fire drills monthly.

A deficiency is being cited as a result of today’s inspection and is documented on the attached LIC809-D. LPA observed outdoor stone stairs that do not have a hand rail.

Exit interview conducted and copy of report was provided to administrator Chase Puckett.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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Document Has Been Signed on 08/13/2024 02:33 PM - It Cannot Be Edited


Created By: Rebecca Knight On 08/13/2024 at 10:56 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: PRS - BAKER HOUSE
FACILITY NUMBER: 525000407

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85087(b)
Building and Grounds
(b) Stairways, inclines, ramps, open porches, and areas of potential hazard to clients whose balance or eyesight is poor shall not be used by clients unless such areas are well lighted and equipped with sturdy hand railings.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in 1 of 1 outdoor stairway handrails. LPA observed outdoor stone stairs that do not have a hand rail which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2024
Plan of Correction
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Licensee agrees to install a hand rail on the outdoor stairway. Licensee shall make the stairs inaccessible until repair is complete.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Rebecca Knight
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
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