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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002575
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:35:42 AM

Document Has Been Signed on 01/14/2025 11:35 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:D & S CARE HOMES, LLCFACILITY NUMBER:
525002575
ADMINISTRATOR/
DIRECTOR:		BORTZ, JR., DAVIDFACILITY TYPE:
735
ADDRESS:320 CHRISTINA DRIVETELEPHONE:
(530) 727-6141
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 5CENSUS: DATE:
01/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:49 AM
MET WITH:Davic Bortz - licensee / administratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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01/14/2025 09:45 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator/licensee David Bortz. Administrator cert #7001864735 exp. 07/05/2025. LPA explained the purpose of the visit.

LPA Knight and staff toured the facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to five (5) client rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. All employees requiring background checks are cleared.

The facility takes the clients out on group outings in the community at the client's choosing. Activities in the home are tailored to the client's preferences and abilities. Bedding, linens, and towels for clients were observed and found to be clean and in good repair. There is an adequate supply of toiletries for the clients. Medication is locked in a cabinet.

The facility was observed to be at a comfortable temperature. Hot water measured between 105 – 120 degrees F. Common area, bathrooms, kitchen and storage areas were observed to be clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Fire extinguishers fully charged and were inspected in February 2024. Smoke detectors are all operational. No pools/bodies of water are on premises. The facility has been conducting emergency disaster drills every 6 months and fire drills monthly.

LPA requested the following to update the facility file: LIC500 Personnel report, administrator certificate.

The following deficiencies were observed during the inspection and are documented on the attached LIC809-D. LPA observed discarded washer and other debris that needs to be removed from the side yard of the facility.
Exit interview conducted and copy of report was provided to licensee David Bortz.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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Document Has Been Signed on 01/14/2025 11:35 AM - It Cannot Be Edited


Created By: Rebecca Knight On 01/14/2025 at 11:18 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: D & S CARE HOMES, LLC
FACILITY NUMBER: 525002575

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility 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
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Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed discarded washer and other debris that needs to be removed from the side yard of the facility.
POC Due Date: 01/31/2025
Plan of Correction
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Licensee shall remove all discrded items from the premises of the facility. Licensee shall submit photograph to LPA as prrof of correction.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2025


LIC809 (FAS) - (06/04)
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