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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804082
Report Date: 07/13/2023
Date Signed: 07/13/2023 12:58:21 PM


Document Has Been Signed on 07/13/2023 12:58 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:RUBY HOMEFACILITY NUMBER:
486804082
ADMINISTRATOR:BUNYI, LEONILAFACILITY TYPE:
740
ADDRESS:1679 TUCSON CIRCLETELEPHONE:
(707) 759-5173
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY:5CENSUS: 4DATE:
07/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Leonila Bunyi, AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Nakagawa conducted an unannounced Required 1-Year Inspection of this licensed adult residential care facility on 7/13/23 at approximately 9:50 AM and was greeted by caregiver. Licensee/Adminstrator Leonila Bunyi arrived shortly. At the time of inspection there were 4 clients in care, 1 of whom was at Day Program, and 2 care staff on site in addition to the Administrator.

LPA toured building and grounds which were found to be clean and in good repair. Facility was a comfortable temperature of 72 F and exits were free from obstructions. There are a total of four bedrooms. Bedrooms had required furnishings. Bathrooms were equipped with necessary grab bars and non-slip floor mats. Extra linens and towels were available for clients. Facility has a large living room for activities and a backyard with shade and a lovely fig tree. Water temperature was measured at 114.0 degrees F. Toxins were secured and inaccessible in a locked cabinet in the garage. Fire extinguishers were last inspected on 4/19/23. LPA observed necessary complaint and personal rights postings. Medications were stored inaccessible to residents in a locked cabinet in the kitchen.

No deficiencies cited during this inspection. Exit interview conducted with licensee and a copy of this report was given during the visit.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023
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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