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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005738
Report Date: 07/18/2024
Date Signed: 07/22/2024 02:55:37 PM

Document Has Been Signed on 07/22/2024 02:55 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:
07/18/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:William PuckettTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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A Non-Compliance Conference (NCC) was conducted on this day in the Sacramento South Regional Office via Microsoft Teams. The purpose of this Non-Compliance Conference meeting was to follow up on a previous citation issued to facility . Present in the meeting was Regional Manager (RM) Stephanie Doub, Licensing Program Manager (LPM) Liza King, Licensing Program Analyst (LPA) Kesha Lewis, Ombudsman Kathryn Thomas, and Licensee William Puckett, Chris Pillsbury, kitina Ritchion and Robert Fernandez from Valley Mountain Regional . The Non-Compliance Conference process was explained during this meeting to include the Administrative Process.

Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates:


(1) Presence of the administrator at least 40 hours per week, (2) Updated LIC 200, (3) updated LIC 500, (4) Checklists of staff responsibilities (5) Licensees plan for unannounced visits, (6) Personal rights training for all staff, (7) Mandated reporting training for all staff. These are due to the department by COB 07/25/2024. Additionally the Regional Office will start unannounced quarterly visits to monitor the above and overall regulatory compliance.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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