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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525000804
Report Date: 01/21/2025
Date Signed: 01/21/2025 02:16:15 PM

Document Has Been Signed on 01/21/2025 02:16 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: DATE:
01/21/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Esperanza Chavez - administratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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01/21/2025 01:30 PM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with administrator Esperanza Chavez. The purpose of this visit was conduct a plan of correction inspection.

On a prior visit LPA observed multiple large cracks in the pavement in the patio area in between the office and activities room and substantiated a physical plant deficiency.

During today’s visit LPA observed the cracks had been ground down level and filled with waterproof flex sealer to even the surface. This fulfills the plan of correction for the deficiency that was issued on 12/10/2024. LPA will issue the proof of correction letter to facility.

No deficiencies were issued as a result of today's visit. An exit interview was conducted and the report was provided to administrator Esperanza Chavez.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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