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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525920242
Report Date: 12/16/2024
Date Signed: 12/16/2024 11:02:25 AM

Document Has Been Signed on 12/16/2024 11:02 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:PRS JUANITA COURTFACILITY NUMBER:
525920242
ADMINISTRATOR/
DIRECTOR:		JACKSON, DAWNFACILITY TYPE:
735
ADDRESS:22655 JUANITA COURTTELEPHONE:
(530) 526-3831
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 6CENSUS: 0DATE:
12/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Gail Palmer - licenseeTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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12/16/2024 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct their scheduled pre-licensing inspection. LPA met with Licensee Gayle Palmer, and administrators Laurie Schlottman, Dawn Jackson, Mendee Harrong and Tanner Puckett and explained the purpose of the visit.

LPA toured the facility inside and out. The inside of the facility was observed to be in good condition and repair. The licensee will be moving the clients from PRS Sherman House to the new facility once licensing has been completed. The facility has received fire clearance for six (6) ambulatory clients. The facility has four (4) bedrooms and two (2) bathrooms. The licensee will be moving the furniture from the Sherman location to the Juanita Court location once licensing has been completed for the new facility.



Food storage meets Title 22 regulation requirements. Dishwasher, stove, microwave, and refrigerator were all present and working.

The facility has two fully charged fire extinguishers which have been inspected by the fire marshal. LPA observed smoke alarms and carbon monoxide detectors fully functioning.

Continued on LIC809-C

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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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: PRS JUANITA COURT
FACILITY NUMBER: 525920242
VISIT DATE: 12/16/2024
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Clients will be moving in from their previous home with their bedroom furniture and belongings. All beds will be made up with linens and bedspreads. The facility has a linen closet which will contain towels and extra linens and bedding. Bathrooms were observed to be in good repair.

Storage and lighting are adequate in the home. Medications are to be stored in a locked cabinet. Cleaning supplies and toxins will be locked up in a cabinet. Knives will be secured. Washer and dryer will be moved over from the PRS Sherman House when the clients move in.

The office space will be located in the common area and will have a locked area for client files. Staff files will be located at the corporate office and available to licensing upon request.

The back yard has many shade trees and the licensee will move lawn furniture from PRS Sherman House for clients to use.

There is a built-in swimming pool that has a chain link fence with a locked gate, the pool is inaccessible to clients.

The applicant has passed the pre-licensing portion of the application process. LPA will contact the Central Application Bureau.

Exit Interview and copy of report was provided to the licensee.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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