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ICF/DD-H (Habilitative)License activeMedi-Cal certified

BUTLER VALLEY

ICF/DD-H (Habilitative) · 6 licensed beds · Arcata, CA

Homes of 4–15 beds for people with developmental disabilities whose nursing needs are intermittent and predictable.

Address

BUTLER VALLEY380 12TH STArcata, CA 95521 · Humboldt County

Phone: (707) 822-0301

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-H (Habilitative)
Licensed beds
6
Licensee
BUTLER VALLEY INC. · Nonprofit Corp
Administrator
OTT, SUZETTE M
CDPH facility ID
010000087
License number
010000138
First licensed
September 14, 1983
Current license
Nov 14, 2025 to Nov 13, 2026
CDPH district office
Santa Rosa

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
05G102
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
September 14, 1983
Last certification survey
October 22, 2025
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (non-profit)
Certified beds (CMS)
6
Staffing reported to CMS
RN 0.26 · LVN/LPN 0 · direct care 12.95 · all employees 13.21

State citations and penalties (CDPH)

2 penalties, newest first

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

  • Class BPatient Care

    Citation B (HSC 1424) · Violation Aug 1, 2006 · Penalty #110003902 · Survey F6MU11

    Status: Closed · Not appealed

    $500

  • Class BPhysical Environment

    Citation B (HSC 1424) · Violation Jan 18, 2001 · Penalty #010001880

    Status: Closed · Not appealed

    $1,000

Federal inspections (CMS-2567)

23 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Complaint

    Event 2304B0-H1 · 1 deficiency

    Official 2567 ↗
  2. · Complaint

    Event G0E511 · no deficiencies cited

    Official 2567 ↗
  3. · Recertification

    Event 88JT21 · 4 deficiencies

    Official 2567 ↗
  4. · Complaint, Recertification

    Event 88JT11 · 3 deficiencies

    Official 2567 ↗
  5. · Complaint

    Event 3EI311 · 3 deficiencies

    Official 2567 ↗
  6. · Complaint

    Event 510M11 · 1 deficiency

    Official 2567 ↗
  7. · Complaint

    Event PI8D11 · no deficiencies cited

    Official 2567 ↗
  8. · Complaint

    Event UVO411 · 1 deficiency

    Official 2567 ↗
  9. · Recertification

    Event T6T021 · 4 deficiencies

    Official 2567 ↗
  10. · Recertification

    Event T6T011 · 9 deficiencies

    Official 2567 ↗
  11. · Complaint

    Event 5KAT11 · 7 deficiencies (1 condition-level)

    Official 2567 ↗
  12. · Complaint

    Event CKGL11 · 1 deficiency

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

26 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  2. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  3. ReportFederal survey (recertification): 4 deficiencies(state record)

    See this survey →
  4. ReportFederal survey (complaint, recertification): 3 deficiencies(state record)

    See this survey →
  5. ReportFederal survey (complaint): 3 deficiencies(state record)

    See this survey →
  6. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  7. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  8. ReportFederal survey (complaint): 1 deficiency(state record)

    See this survey →
  9. ReportFederal survey (recertification): 4 deficiencies(state record)

    See this survey →
  10. ReportFederal survey (recertification): 9 deficiencies(state record)

    See this survey →

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.