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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804082
Report Date: 11/22/2022
Date Signed: 11/22/2022 03:31:14 PM

Document Has Been Signed on 11/22/2022 03:31 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: 0DATE:
11/22/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Leonila BunyiTIME COMPLETED:
03:41 PM
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Licensing Program Analyst (LPA) Walters conducted an unannounced post licensing inspection of this licensed adult residential care facility and was greeted by licensee/Administrator, Leonila Bunyi. At the time of inspection there were no clients in care . The facility is still undergoing the vendorization process with North Bay Regional Center.

LPA toured building and grounds which were found to be clean and in good repair. Facility was a comfortable temperature and exits were free from obstructions. There are a total of four bedrooms, one of which is shared. 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. Water temperature was measured at 120.0 degrees F. Toxins were secured and inaccessible in a locked cabinet in the garage. Fire extinguishers were last charged 02/22/2022. LPA observed necessary complaint and personal rights postings.

LPA requested that the facility sends a current copy of Liability Insurance by 11/30/22.

No deficiencies cited during this inspection. Exit interview conducted with licensee and a copy of this report was given during the visit.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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