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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340302276
Report Date: 06/13/2024
Date Signed: 06/13/2024 05:45:13 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/13/2024 05:45 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:FLOWERDALEFACILITY NUMBER:
340302276
ADMINISTRATOR/
DIRECTOR:		HUFFHINES, JERRY L.FACILITY TYPE:
735
ADDRESS:7446 8TH STREETTELEPHONE:
(916) 991-3791
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY: 11CENSUS: DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Jeffery Hufhines, Administrator Attempted VisitTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Attempted visit-
On June 13, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons went to facility to conduct an annual inspection, however, Jerry was not home at the time. I informed the caregiver I would return today if time permits.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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