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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701513
Report Date: 02/21/2025
Date Signed: 02/21/2025 02:49:02 PM

Document Has Been Signed on 02/21/2025 02:49 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:WILLIAM'S HOUSEFACILITY NUMBER:
342701513
ADMINISTRATOR/
DIRECTOR:		JOSEPH, DIVINA TFACILITY TYPE:
735
ADDRESS:12301 COAL CREEK WAYTELEPHONE:
(916) 230-3251
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY: 4CENSUS: 0DATE:
02/21/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Divina JosephTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 02/21/25, Licensing Program Analyst (LPA) Kimberly Viarella made an announced visit to this facility to conduct a pre-licensing inspection. LPA identified herself upon arrival and stated the purpose of the visit. LPA met with the Administrator, Divina Joseph and Licensee, Verneet Flores. A brief interview followed.

LPA Viarella reviewed the infection control plan and the emergency disaster plan. This LPA also observed the physical plant to ensure compliance with Title 22. LPA observed the common areas to be clean, organized, and free from debris.

LPA observed that all 4 resident bedrooms had the required furniture, furnishings and lighting to be in compliance at the time of this inspection.

All bathrooms were equipped with hand soap, paper towels and trash cans with lids. The hot water was measured and found to be 108.6 degrees Fahrenheit and was also in compliance.

All chemicals and cleaning supplies were observed to be locked in a closet and inaccessible to future residents in care.

LPA observed that the first aid kit contained all of the required elements and was in compliance at the present time. LPA also observed the locked kitchen cabinet where client medications will be stored and all sharps were in a separate locked drawer. It was also observed that all of the required signage was posted in plain view.

The fire extinguisher was last inspected on 6/25/24 by Sacramento Fire Company and was in compliance at the time of this inspection.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: WILLIAM'S HOUSE
FACILITY NUMBER: 342701513
VISIT DATE: 02/21/2025
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According to California Code of Regulations, Title 22, there were no deficiencies observed during today's visit.

LPA proceeded to and completed Component III with the Licensee. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed.

LPA reminded the Licensee and Administrator that they must notify Community Care Licensing (CCL) as soon as they accept their first resident so that CCL may schedule a post-licensing inspection.

A copy of this report was provided and exit interview was conducted.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
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