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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002751
Report Date: 05/21/2024
Date Signed: 05/21/2024 02:26:59 PM

Document Has Been Signed on 05/21/2024 02:26 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:D & S CARE HOMES, LLCFACILITY NUMBER:
525002751
ADMINISTRATOR/
DIRECTOR:		BORTZ JR, DAVID L.FACILITY TYPE:
735
ADDRESS:760 MELTON COURTTELEPHONE:
(530) 864-2341
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 4CENSUS: 3DATE:
05/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:David Bortz - licensee/administratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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05/21/2023 12:00 PM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with licensee/administrator David Bortz and explained the purpose of the visit.

LPA Knight and the administrator toured the facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to four (4) 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. Administrator certificate is current. Medications were reviewed.

Clients participate in activities of their choice. Bedding, linens, and towels for clients were observed and found to be clean and in good repair. Medication is locked in a cabinet.

The facility was observed to be at a comfortable temperature. Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. 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 March 2024. Smoke detectors are all operational. No pools/bodies of water are on premises. Last disaster drill was conducted in March 2024, which was an flood drill, the facility has been conducting fire drills monthly.

Continued on LIC809-C
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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 05/21/2024 02:26 PM - It Cannot Be Edited


Created By: Rebecca Knight On 05/21/2024 at 01:40 PM
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: 525002751

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2024

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 LPA 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.Back fence needs to be repaired or replaced. Bedroom 4 has significant amount of new items that belong to the client stored in the room. If client purchases any more large items they need to be placed in a storage unit.
POC Due Date: 06/18/2024
Plan of Correction
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Licensee agrees to repair or replace back fence. Bedroom 4 has significant amount of new items that belong to the client stored in the room. If client purchases any more large items they need to be placed in a storage unit. Licensee agrees to explain this requirement to the client. Licensee has offered the use of a company storage unit to client for this purpose.
Type B
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

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/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/22/2024
Plan of Correction
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Licensee agrees to turn up water heater. LPA measured water temperature as 102 degrees faranheit which is lower than the lowest required temperature of 105 degrees farenheit.
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: 05/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, LLC
FACILITY NUMBER: 525002751
VISIT DATE: 05/21/2024
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LPA requested the following documents that need to be updated in the facility file:
LIC500 Personnel Report

Deficiencies are being cited as a result of today’s inspection.

LPA observed that the back fence needs to be repaired or replaced. Bedroom 4 has significant amount of new items that belong to the client stored in the room. If client purchases any more large items they need to be placed in a storage unit.

LPA measured water temperature at 102 degrees Fahrenheit which is lower than the lowest required temperature of 105 degrees Fahrenheit. Licensee shall turn up water heater.

Exit interview conducted and copy of report was provided to administrator David Bortz.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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