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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005738
Report Date: 07/05/2024
Date Signed: 07/05/2024 02:53:30 PM

Document Has Been Signed on 07/05/2024 02:53 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:
07/05/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Lynette MooreTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 7/05/24 at approximately 9:00am Licensing Program Analysts (LPA'S) Kesha Lewis and Maja Jenson conducted a case management visit to the facility for the purpose of delivering an Order To Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion From Facility. LPA'S Lewis and Jenson met with Staff and, LPA explained the purpose of today's visit. Staff (S-1) excluded as a result on and ongoing complaint investigation.

LPA'S Lewis and Jenson handed the Order to Licensee/Facility of Immediate Exclusion From Facility letter to staff and explained that staff must not come back to the facility.

S1 has not been at the facility since 06/24/2024. S2-S3 were also interviewed during todays visit.

No citations were issued on today's date. A copy of the report was provided to Administration.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2024
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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