<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390302236
Report Date: 03/21/2023
Date Signed: 03/21/2023 12:22:53 PM

Document Has Been Signed on 03/21/2023 12:22 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:HUBER'S GUEST HOMEFACILITY NUMBER:
390302236
ADMINISTRATOR:HUBER, RICKYFACILITY TYPE:
735
ADDRESS:18759 N. CHESTNUT ST.TELEPHONE:
(209) 368-8330
CITY:WOODBRIDGESTATE: CAZIP CODE:
95258
CAPACITY: 15CENSUS: 13DATE:
03/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ricky Huber, AdministratorTIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced Annual 1-Year Required visit on 03/21/2023. LPA met and toured the facility with Administrator, Ricky Huber. The administrator currently holds a certificate (#6025325735) that expires on 03/11/2025.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 11 total bedrooms. Of the 11 bedrooms, 8 bedrooms are occupied by 13 residents and 2 bedrooms are occupied by 2 staff. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 69 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents.Night lights are maintained in hallways and passages to nonprivate bathrooms. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods.

LPA Campbell reviewed 4 of 13 client files and 2 of 2 staff files.

No deficiencies were cited during this inspection.
Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2