<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525000804
Report Date: 07/29/2024
Date Signed: 07/29/2024 03:39:50 PM

Document Has Been Signed on 07/29/2024 03:39 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/
DIRECTOR:		CHAVEZ, ESPERANZAFACILITY TYPE:
775
ADDRESS:13315 BAKER RDTELEPHONE:
(530) 528-1083
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 80CENSUS: 39DATE:
07/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Esperanza Chavez, administratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
07/29/2024 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight
arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Esperanza Chavez and explained the purpose of the visit.

LPA Knight and 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.

The facility was observed to be at a comfortable temperature in the office, meeting room, kitchen and the right side of the common area / activity room. LPA observed that the central air conditioning unit was not functioning on the left side of the common area / activity room. LPA observed a portable air conditioning unit and fans on the left side of the common area which is inadequate to cool that large a space. On the day of the inspection the room was relatively cool but the outside air temperature was 79 degrees which is significantly cooler than it has recently been. Administrator confirmed that they have obtained an estimate from a company to replace the unit. No date of replacement has been confirmed this date. When temperatures rise staff have been moving the clients to the conference room and activity room that is located in the administrative building.

Common areas were clean and in good repair. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Fire extinguishers fully charged and were inspected in June 2024. Last disaster drill was conducted in July 29, 2024 which was an earthquake 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 LIC9099-D. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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
Document Has Been Signed on 07/29/2024 03:39 PM - It Cannot Be Edited


Created By: Rebecca Knight On 07/29/2024 at 11:43 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: NORTH VALLEY SERVICES - BEHAVIOR MANAGEMENT PGRM
FACILITY NUMBER: 525000804

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation the licensee did not comply with the section cited above in the air conditionng unit on the left side of the common area / activity room which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2024
Plan of Correction
1
2
3
4
Licensee agrees to rent or purchase a commercial air conditioning unit that is suitable to cool the size of the left side of the activity room / common area and send LPA a photograph of the unit operating in the day program. This is due by 08/05/2024.
In addition, licensee agrees to send LPA a copy of the signed contract for the installation / repair of the central air conditionining unit that includes the date of repair / replacement once the contract is signed.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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: 07/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2024


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