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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002575
Report Date: 07/26/2022
Date Signed: 07/26/2022 10:30:25 AM

Document Has Been Signed on 07/26/2022 10:30 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:D & S CARE HOMES, LLCFACILITY NUMBER:
525002575
ADMINISTRATOR:BORTZ, JR., DAVID L.FACILITY TYPE:
735
ADDRESS:320 CHRISTINA DRIVETELEPHONE:
(530) 727-6141
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 5CENSUS: 5DATE:
07/26/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica Maldonado - care staffTIME COMPLETED:
11:15 AM
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07/26/2022 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year Inspection. LPA met with care staff Jessica Maldonado and Natasha Petterson and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask, gloves

LPA Knight and facility staff toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, five (5) resident bedrooms, two (2) bathrooms, kitchen, storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Knight and the facility staff completed the inspection and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of today’s inspection. Technical assistance was provided.

Exit interview conducted and copy of report was emailed to licensee David Bortz.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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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