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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623631
Report Date: 01/19/2024
Date Signed: 01/19/2024 09:57:11 AM

Document Has Been Signed on 01/19/2024 09:57 AM - 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HAUBER, DEVAFACILITY NUMBER:
293623631
ADMINISTRATOR:HAUBER, DEVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(917) 627-0103
CITY:NEVADA CITYSTATE: CAZIP CODE:
95959
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Deva HauberTIME COMPLETED:
10:00 AM
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At 9:20am on 1/19/2023, Licensing Program Analyst (LPA) Matthew Gallo met with licensee Deva Hauber for the purpose of conducting a Plan of Correction visit. Today’s census included 0 children.

Licensee was previously cited a Type A deficiency on 10/19/2023 for insufficient fencing of a duck pond. The plan of correction dictated that the licensee would construct a fence that meets all requirements of Title 22 regulations. LPA observed that these corrections have been made: the fence is five feet tall with mesh sidings that prevent access without obstructing view, and features a self-latching gate that swings away from the pond.

The plan of correction for the deficiency cited on 10/19/2023 has been cleared.

Exit interview conducted and report was reviewed with the licensee Deva Hauber. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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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