525002751-3-17-2026-59-AS-RKNT-DS9ND7-20260317102152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525002751
Report Date: 03/17/2026
Date Signed: 03/17/2026 10:22:09 AM

Document Has Been Signed on 03/17/2026 10:22 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, LLC		FACILITY NUMBER:	525002751
ADMINISTRATOR/ DIRECTOR:	BORTZ JR, DAVID L.		FACILITY TYPE:	735
ADDRESS:	760 MELTON COURT		TELEPHONE:	(530) 864-2341
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY: 4		CENSUS: 4	DATE:	03/17/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Janine Pulmones - care staff		TIME VISIT/ INSPECTION COMPLETED:	10:20 AM

NARRATIVE

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03/17/2026 09:30 AM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with staff Janine Pulmones. LPA spoke with licensee Serina Bortz by telephone during the visit. Today’s visit is regarding an incident that occurred on 02/03/2026 and was reported to licensing the same day.

It was reported that on 02/03/2026 8:30am Client 1 (C1) was In the. bathroom doing their morning hygiene tasks with staff. C1 had a seizure and fell, resulting in a ¼ inch long skin tear above their right eye. EMS was called and C1 was transported to the local ER where test were run It was determined that C1 was retaining urine. The skin tear did not require stitches and was glued. C1 was sent home with a catheter for the urine retention. C1 was scheduled for a follow-up appointment with their primary care physician in one week to have the catheter removed and their urine retention assessed.

During the course of the investigation, it was learned that C1 had a follow-up visit with their primary care physician, their physician removed the catheter during the visit. The urinary retention is a part of C1's aging process and is not an acute condition. During the week that C1 had the catheter staff had been trained by the facility's RN on the proper care of a urinary catheter. LPA reminded licensee that if a client has a long term catheter placement they must have a restricted health care plan for the client. The skin tear that was above C1's eye had been taped during the initial visit and has since healed.

In order to prevent this from happening again the facility has reminded staff to remain close to C1 when assisting C1 in case of fall.

No deficiencies were cited as a result of today’s visit. Exit interview conducted and a copy of the report was provided to licensee David Bortz..

NAME OF LICENSING PROGRAM MANAGER: Lauren Crocker
NAME OF LICENSING PROGRAM ANALYST: Rebecca Knight
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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