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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397001861
Report Date: 02/15/2023
Date Signed: 02/15/2023 01:05:07 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/15/2023 01:05 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ESTRELLA WILLIAMS GUEST HOMEFACILITY NUMBER:
397001861
ADMINISTRATOR:ESTRELLA WILLIAMSFACILITY TYPE:
735
ADDRESS:2305 FRESNO AVENUETELEPHONE:
(209) 464-7329
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 6CENSUS: 4DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:E. WilliamsTIME COMPLETED:
12:57 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced annual inspection on this date. LPA met with Administrator and explained the purpose of the visit.

LPA with Administrator inspected physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in/or around the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 107 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees.

Fire extinguishers and smoke detectors are current and in compliance with fire
Safety. Carbon dioxide monitor present and operational. Fire drill was conducted on 2/2023

LPA observed centrally stored medications locked inside the medication cabinet. LPA with the assistance of the Staff reviewed and compared resident medication vs. resident medication logs.

First aid kit was checked and is complete.

No deficiencies were cited during this inspection.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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