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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002751
Report Date: 10/24/2023
Date Signed: 10/24/2023 10:26:48 AM

Document Has Been Signed on 10/24/2023 10:26 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:
525002751
ADMINISTRATOR:BORTZ JR, DAVID L.FACILITY TYPE:
735
ADDRESS:760 MELTON COURTTELEPHONE:
(530) 864-2341
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 4CENSUS: 4DATE:
10/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cathryn Russell - house managerTIME COMPLETED:
10:30 AM
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10/24/2023 9:30 AM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with house manager Cathryn Russell . Today’s visit is regarding an incident that occurred on 09/20/2023 and was reported to licensing on the same day.

It was reported that on 09/20/2023 at 1:00 PM Client 1 (C1) was finishing eating lunch at the dining room table when staff noticed they started to slump over, leaning, almost falling out of their chair. Staff checked C1’s blood pressure and it was 57/43. C1 started becoming non-responsive to staff. 911 was called and C1 was transported to hospital.

During the course of the investigation, it was learned that C1 is high functioning but non-verbal and communicates with their hands. C1 usually has high blood pressure but it is known to drop. The facility checks C1’s blood pressure at every meal. C1 also has a seizure disorder. C1 has a DNR per conservator.

In order to prevent this from happening again the facility will continue to monitor C1’s blood pressure and will ensure C1 stays hydrated. When C1 has low blood pressure staff will continue to monitor it every 15 minutes until it normalizes.

No deficiencies were cited as a result of today’s visit.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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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