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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
525002575
Report Date:
01/26/2023
Date Signed:
01/26/2023 11:38:51 AM
Document Has Been Signed on
01/26/2023 11:38 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
CHICO - RESIDENTIAL
,
520 COHASSET RD., STE. 170
CHICO
,
CA
95926
FACILITY NAME:
D & S CARE HOMES, LLC
FACILITY NUMBER:
525002575
ADMINISTRATOR:
BORTZ, JR., DAVID L.
FACILITY TYPE:
735
ADDRESS:
320 CHRISTINA DRIVE
TELEPHONE:
(530) 727-6141
CITY:
RED BLUFF
STATE:
CA
ZIP CODE:
96080
CAPACITY:
5
CENSUS:
5
DATE:
01/26/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:15 AM
MET WITH:
Serena Aguilar
TIME COMPLETED:
11:45 AM
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LPA Hiratsuka conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wearing masks.
This facility has a fire clearance for five non-ambulatory residents. To the right main entrance has a hallway leading to four private resident rooms and two full common bathrooms. To the left of the main entrance has a doorway leading to the kitchen and a walkway to the main sitting area and dining area. There is a bedroom behind the kitchen and dining area along with a laundry room. The backyard has a storage shed that is used as an office for the licensee. There is a door leading to the backyard from the main sitting area.
Several topics were discussed.
No deficiencies.
SUPERVISORS NAME
:
Lauren Crocker
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/26/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/26/2023
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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