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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005738
Report Date: 07/03/2024
Date Signed: 07/03/2024 03:20:02 PM

Document Has Been Signed on 07/03/2024 03:20 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:INSPIRING CAREFACILITY NUMBER:
397005738
ADMINISTRATOR/
DIRECTOR:		PUCKETT, VICTORIAFACILITY TYPE:
735
ADDRESS:2488 NATHANIEL STREETTELEPHONE:
(209) 951-2405
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 5CENSUS: 4DATE:
07/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Porschia CollinsTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 7-3-24 at 1:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a health and safety check. LPA met with lead caregiver Porschia Collins and explained the purpose of the visit. Administrator William Puckett was not on duty at time of visit and notified via phone of LPA's visit an purpose. LPA conducted physical plant inspection of resident rooms, common areas, kitchen areas, and outside of facility to ensure compliance with Title 22 regulations. LPA also observed two staff on duty and four clients currently in house. LPA reviewed one staff file during today's visit. Facility has appropriate food supply and temperature was 79*F.

Based on today's case management, no citations are issued. An exit interview was conducted with lead caregiver and a copy of this report was provided to lead caregiver.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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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