Senior Care Records.

Facility Evaluation Report

JD Residential-evercare, Shasta Lake03/28/2025Licence 455920269

Capacity6
Census0
Date signed03/28/2025 10:26:12 AM
Name of licensing program analystDiamond Law
Name of licensing program managerBiridiana Cisneros
The inspector’s account

COMP II Participants: Tiffany Battle (Administrator) & Jeremy Potter (CEO)

Interview Method: Virtual interview via Microsoft Teams

On March 28, 2025, applicant(s)/administrator participated in COMP II for the below pending facilities: JD Residential-Evercare/455920269,

JD Residential-Evercare 2/455920284. Identification of the applicant(s) and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant(s) and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:

1. Facility operation: License type, client/resident populations, and program

4. Restrictive/Prohibited Health Conditions

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction