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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002734
Report Date: 01/11/2025
Date Signed: 01/11/2025 04:09:46 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/11/2025 04:09 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:ESTRELLA WILLIAMS GUEST HOME 2FACILITY NUMBER:
397002734
ADMINISTRATOR/
DIRECTOR:
WILLIAMS, ESTRELLAFACILITY TYPE:
735
ADDRESS:1925 ST. LAKES WAYTELEPHONE:
(209) 948-1891
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 6CENSUS: 4DATE:
01/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Estrella WilliamsTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Albert Johnson conducted unannounced required 1 year annual inspection visit. LPA met with Administrator and explained purpose of visit.

LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; client bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in kitchen sink at 109.5 degrees Fahrenheit which is within the required range of 105 to 120 degrees.

Fire extinguishers last inspected on 8/7/2024. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to clients. LPA reviewed and compared client medication vs. medication logs. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. The facility conducts fire/disaster drills with residents on 12/3/2024.

LPA reviewed four client files and two staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. Exit interview held with administrator.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2025
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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