397002734-1-13-2026-27-AS-NWPN-DQAUZB-20260113150115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 397002734
Report Date: 01/06/2026
Date Signed: 01/13/2026 03:01:40 PM

Document Has Been Signed on 01/13/2026 03:01 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 2		FACILITY NUMBER:	397002734
ADMINISTRATOR/ DIRECTOR:	WILLIAMS, ESTRELLA		FACILITY TYPE:	735
ADDRESS:	1925 ST. LAKES WAY		TELEPHONE:	(209) 948-1891
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY: 6		CENSUS:	DATE:	01/06/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:24 PM
MET WITH:	Estrella Williams		TIME VISIT/ INSPECTION COMPLETED:	02:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst, LPA, arrived unannounced to the facility for an annual inspection. LPA met with the administrator and explained the purpose of the visit, Estrella Williams Guest Home 2 is a 6 capacity adult residential facility serving clients aged 18-59, the current census is 4. 2 clients have non-insulin dependant diabetes, controlled with special diet, exersise, and oral medication. All clients are ambulatory. There are some toddlers, in the facility being supervised by the staff. LPA notes that the plan of operation notes the facility is specific for care and supervision of adults 18-59, and could be cited in the future if operating outside that bounds. LPA gave guidance that the parents of the toddlers would have to come to a different solution for child care immediately. Licensee provided its not a regular occurance, characterized the presence of the children as a one-time, emergency situation. Physical Plant inspection was conducted, including but not limited to the kitchen, bedroom, bathrooms, common areas, storage areas, exteriors, and evacuation gates. The facility is clean and traffic areas are unobstructed and well lit. The kitchen has adequate lockable storage for sharps, toxics, and medications. There is food storage for 2 days perishable and 7 days nonperishable food. The bedroom has appropriate furniture and furnishings, including mattress encasements. The bathrooms have hardware in good repair, sink water is measured at 119.4*F. common areas and exteriors have space for activites, exterior walking surfaces could use a little powerwashing to remove slipping hazzards presented by fallen ripened persimmon fruits. Evacuation route gate is swinging freely and latching closed, LPA gave guidance to remove the nail with a wire on it as the evacuation route gate is not supposed to be obstructed. continued on c page

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Noel Wolf Petersen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: ESTRELLA WILLIAMS GUEST HOME 2	FACILITY NUMBER: 397002734
	VISIT DATE: 01/06/2026

NARRATIVE

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P+I, Two clients were checked at random and found thier safegaurded cash to line up
with thier stated balances. One client manages his own monies.

Medcations were checked for 2 clients at random, and found thier pills lined up with thier distribution tallies.

4 of 4 Client files were reviewed, including the admission agreement, personal property, Ipp, Recent medical evaluation, needs and services plan, and functional cababliity assesment. Present and up to date.

4 of 4 Staff files were reviewed, including the continued training, first aid, criminal backround check and finger printing. LPA gave guidance it would be good to have at least 1 on-call staff in case somebody needs to take off for an emergency, as right now the business is at skeleton crew type levels.

Administrator files were reviewd including facility sketch, which should be updated with the fire department as to what is a staff room and what is a client room, the faciility posters are present of the correct dimension, the infecton control plan and evacuation control plan were reviewed. surety bond is present and up to date. and control of the property via deed should be sent to the lpa, noel.wolfpetersen@dss.ca.gov.

Fire extinguisher is dated 8/14/25, smoke alarm is functional, first aid kit has all required items.

1 staff were interviewed, 2 client was interviewd.

no citations at this time, a copy of the report was read and given to the administrator, an exit interview was conducted.

NAME OF LICENSING PROGRAM MANAGER: Liza King
NAME OF LICENSING PROGRAM ANALYST: Noel Wolf Petersen
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC809 (FAS) - (06/04)

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