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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005123
Report Date: 12/13/2021
Date Signed: 12/13/2021 04:26:57 PM

Document Has Been Signed on 12/13/2021 04:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:PAULETTE, PHOEBE & HOWARD'S FAMILY HOMEFACILITY NUMBER:
317005123
ADMINISTRATOR:HUNTSBERRY, HOWARDFACILITY TYPE:
735
ADDRESS:1899 DELOUCHTELEPHONE:
(916) 409-9391
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 4CENSUS: 2DATE:
12/13/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Howard HuntsberryTIME COMPLETED:
03:45 PM
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An office meeting was virtually conducted today with Licensing Program Manager Anthony Perez, Licensing Program Analyst Melissa Lusby, ALTA Service Coordinator October King, and Administrator Howard Huntsberry. The purpose of the meeting was to discuss the incident which occurred on 11/17/2021 with R1. Also discussed was the facility's history of compliance.

The Facility has been cited approximately 9 times in the last 5 years. The facility was cited for the following issues: health related services (5/2017), personal rights (8/2017), health related services (9/2017), food services (7/2018), health related services and responsibility for providing care and supervision (10/2018), food services (5/2019), personal rights (8/2020), and responsibility for providing care and supervision (6/2021).

Issues discussed during the meeting:
  • handling difficult clients
  • staff training

Also discussed, contacting the facility's ALTA liaison to coordinate staff training with an ALTA Behaviorist.

Exit interview conducted. A copy of this report was emailed to Administrator to sign and return. A hard copy of the report will be left in the facility file.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Melissa Lusby
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2021
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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