397203009-3-10-2026-27-AS-CYAG-DS2UNB-20260310154340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 397203009
Report Date: 03/06/2026
Date Signed: 03/10/2026 03:43:46 PM

Document Has Been Signed on 03/10/2026 03:43 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:	MICHAEL'S RESIDENTIAL HOME CARE		FACILITY NUMBER:	397203009
ADMINISTRATOR/ DIRECTOR:	OGBUEHI-NZAMBI, VICTORIA		FACILITY TYPE:	735
ADDRESS:	5125 JETTY DRIVE		TELEPHONE:	(209) 234-2215
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY: 6		CENSUS:	DATE:	03/06/2026
TYPE OF VISIT:	Office	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Victoria Ogbuehi-Nzambi		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

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	The Sacramento South Regional Office held an office meeting via Microsoft teams on 03/06/2026. The purpose of the meeting was to discuss Solvency and Trust Audit Report Findings from Quarter 3 monitoring. Present in today's meeting were Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Charlie Yang, Licensee/Administrator Victoria Ogbuehi- Nzambi, and Anna Sims from Valley Mountain Regional (VMRC). Below is a summary of the Departments findings at this time: The mortgage statements provided by the licensee show that each of the two facilities’ mortgages were paid for the months of July, August and September 2025 which demonstrated that the licensee had control over both facilities. The review of the utility records from the third-party vendors showed that the licensee made full payments consistently for the utilities such as gas, electricity, garbage, phone, and water during the review period of July, August, and September 2025. Additionally, the provided Bank of America statements and Valley Strong Credit Union statements showed that the licensee had adequate cash reserves enough to cover more than one month’s operating expenses for both facilities in case of a financial emergency. Necessary Insurance coverages were current and up to date. Therefore, upon review of all the records provided, it appeared the licensee had an adequate financial plan, as required by law. Overall, they have made improvements; however, there were areas such as depositing and supporting all revenues in the facility’s (Michael’s Residential Home, Inc) account that needed some improvement.

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Charlie Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MICHAEL'S RESIDENTIAL HOME CARE	FACILITY NUMBER: 397203009
	VISIT DATE: 03/06/2026

NARRATIVE

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The bank statements showed lower balances when compared with the operating expenses. The lower balances were therefore not able to cover the facility’s one month’s operating expenses. However, the cash reserves in the licensee’s personal account balance, could be considered as adequate to cover the operating expenses of the facility in the case of a financial emergency since this facility was licensed under the owner’s name.

Based on the review the Department will discontinue quarterly monitoring at this facility. Should there be any concerns related to the food supply, utilities or staffing this Department may move forward in taking Administrative Action against this facility.
No citations were issued during today's meeting, a copy of this report was reviewed with the licensee and a copy was sent via email for signature.

Please return the signed copy via email to Charlie.Yang@dss.ca.gov.

Exit Interview

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Charlie Yang
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC809 (FAS) - (06/04)

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