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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005123
Report Date: 07/08/2026
Date Signed: 07/08/2026 11:45:44 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2026 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260406141644
FACILITY NAME:PAULETTE, PHOEBE & HOWARD'S FAMILY HOMEFACILITY NUMBER:
317005123
ADMINISTRATOR:HUNTSBERRY, HOWARDFACILITY TYPE:
735
ADDRESS:1899 DELOUCH DRTELEPHONE:
(916) 409-9391
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:4CENSUS: 3DATE:
07/08/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Howard HuntsberryTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff caused injury to client
Reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Wednesday July 8, 2026, to deliver findings for a complaint received on 4/6/2026. LPA met with Administrator Howard and explained the purpose of the visit.

During the investigation, the Department conducted interviews and obtained documentation pertinent to the investigation. The result of the investigation is as follows:

Interviews conducted indicated on April 3, 2026, S1 punched R1 on the left side of their face. According to R1’s medical records, R1 sustained a fractured nose and left orbital bone. S2 observed S1 punching R1 in the face. S1 was interviewed and admitted they punched R1 after R1 startled them by grabbing the left side of their face. According to behavior records, R1 had the following incidents which were not reported to the Department: R1 had documented behaviors on 12/8/2025, 12/12/2025, 12/26/2025, 2/4/2026, 3/13/2026, and 3/31/2026. On 04/03/2026, S1 was arrested for felony elder abuse.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 59-AS-20260406141644
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PAULETTE, PHOEBE & HOWARD'S FAMILY HOME
FACILITY NUMBER: 317005123
VISIT DATE: 07/08/2026
NARRATIVE
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Based on interviews conducted and documentation obtained, the preponderance of evidence standards has been met. Therefore, the above allegations is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached 9099-D page. As a result of the resident's serious bodily injury, an immediate civil penalty per Health and Safety Code § 1548 in the amount of $500 is being assessed for a violation that the Department determines resulted in the injury or illness of a person in care. An additional civil penalty assessment is under review and determination is pending. LPA will return on a future date to assess an additional civil penalty if warranted.

See 9099-D for citations

Exit interview conducted. A copy of the report and appeal rights provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20260406141644
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PAULETTE, PHOEBE & HOWARD'S FAMILY HOME
FACILITY NUMBER: 317005123
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2026
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights
(a) . .each client shall have personal rights which include, but are not limited to, the following:(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other
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Facility to submit personal rights training for each staff.
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actions of a punitive nature, . . .This requirement was not met as evidenced by S1 assaulting R1 resulting in serious injury. This poses a direct threat to clients in care.
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Type B
07/22/2026
Section Cited
CCR
80061(b)(1)(E)
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(b) Upon the occurrence . . ., a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event.
(1) Events reported shall include the following: (E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.
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Administrator will review reporting requirement regulations and submit a statement of understanding
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This requirement was not met as evidenced by R1 having documented behaviors which threatened the health and safety of the client in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3