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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390302236
Report Date: 03/03/2025
Date Signed: 03/03/2025 12:20:15 PM

Document Has Been Signed on 03/03/2025 12:20 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HUBER'S GUEST HOMEFACILITY NUMBER:
390302236
ADMINISTRATOR/
DIRECTOR:		HUBER, RICKYFACILITY TYPE:
735
ADDRESS:18759 N. CHESTNUT ST.TELEPHONE:
(209) 368-8330
CITY:WOODBRIDGESTATE: CAZIP CODE:
95258
CAPACITY: 15CENSUS: 13DATE:
03/03/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:HUBER, RICKYTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA) Kesha Lewis arrived at this facility unannounced to conduct a case management visit. LPA was met by administrator. LPA explained the purpose of the visit.

The department was sent an updated roster on 02/25/2025. A person was written on the roster that can not be found in guardian. Facility was able to provide finger prints for the person dated 10/19/1984. and a previous roster with them listed in guardian from 2003. Administrator stats this person is his sister and he has never disassociated this person from the facility.

This matter is still under investigation. Administrator was informed to not have this person in the facility until this matter was resolved.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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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