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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525000804
Report Date: 06/20/2023
Date Signed: 06/20/2023 12:42:27 PM

Document Has Been Signed on 06/20/2023 12:42 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:NORTH VALLEY SERVICES - BEHAVIOR MANAGEMENT PGRMFACILITY NUMBER:
525000804
ADMINISTRATOR:CHAVEZ, ESPERANZAFACILITY TYPE:
775
ADDRESS:13315 BAKER RDTELEPHONE:
(530) 528-1083
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 80CENSUS: 40DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Esperanza Chavez - administratorTIME COMPLETED:
01:00 PM
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06/20/2023 10:30 AM Licensing Program Analyst (LPAs) Rebecca Knight and Jaynae Boyles arrived at the facility unannounced to conduct a Required-1 Year inspection. LPAs met with administrator Esperanza Chavez and explained the purpose of the visit.

LPAs Knight, Boyles the administrator toured the facility together to ensure the health and safety of clients who attend program. Areas toured include but are not limited to common areas in two buildings, bathrooms, kitchen, storage areas and patio area. Staff and resident files were reviewed. All employees requiring background checks are cleared.

There is a schedule of recreational activities planned for the clients. Medication is locked in a cabinet.

The facility was observed to be at a comfortable temperature. Common areas were clean and in good repair. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Food appears to be stored properly. Fire extinguishers fully charged and were inspected in May 2023. Smoke detectors are all operational. No pools/bodies of water are on premises. No firearms are on premises. Last disaster drill was conducted in May 2023 which was a suspicious package drill, the facility has been conducting fire drills monthly..

In the areas toured no immediate health, safety, or personal rights violations were observed. No deficiencies are being cited as a result of today’s inspection. Technical assistance was provided.

Exit interview conducted and copy of report was provided to administrator Esperanza Chavez

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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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