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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005738
Report Date: 11/16/2023
Date Signed: 11/17/2023 08:22:26 AM

Document Has Been Signed on 11/17/2023 08:22 AM - 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:INSPIRING CAREFACILITY NUMBER:
397005738
ADMINISTRATOR:PUCKETT, VICTORIAFACILITY TYPE:
735
ADDRESS:2488 NATHANIEL STREETTELEPHONE:
(209) 951-2405
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 5CENSUS: 4DATE:
11/16/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:William PuckettTIME COMPLETED:
03:30 PM
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On 11-16-23 at 3:00pm a meeting was held via Microsoft teems to review the facility's compliance with the quarterly visits. Present at this meeting were Licensing Program Analyst (LPA) Michael Bilger, Licensing program manager (LPM) Liza King, Licensee William Puckett, and assistant facility administrator Carrie Mumphrey. Since October 2022, Licensee has received two annual visits and multiple case management to ensure compliance with Title 22 regulations. Licensee stated during meeting that checklist are in place to help staff maintain compliance going forward. Facility has maintained overall compliance in the areas of physical plant, incident reporting, medication procedures, record keeping, resident rights, care and supervision, and staffing levels.

At this time the department finds the facility to have been in compliance with the requirements for the quarterly visits and the department has no concerns regarding the facility at this time. Therefore, the quarterly visits will cease. Additionally, the Department has lifted the requirement of Administrator of Record on duty at least 40 hours per week previously imposed.

An exit interview was conducted with William Pucket and a copy of this report was emailed to William with request for return with signature.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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