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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005738
Report Date: 08/16/2024
Date Signed: 08/16/2024 03:23:57 PM

Document Has Been Signed on 08/16/2024 03:23 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:		WILLIAM PUCKETTFACILITY TYPE:
735
ADDRESS:2488 NATHANIEL STREETTELEPHONE:
(209) 951-2405
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 5CENSUS: 3DATE:
08/16/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Porschia Collins TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 8-16-24 at 2:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a health and safety case management visit. LPA met with lead caregiver Porschia Collins (S1) and explained the purpose of the visit. Administrator was off duty for today and gave permission for S1 to sign in his absence. LPA conducted brief interviews with S1 and resident1 (R1). LPA observed facility to be clean and sanitary throughout with no excessive stains on walls or floors. No malodorous environments noted. Facility is maintaining a temperature of 79*F. All toxins and other dangerous items are locked and inaccessible to residents in care.

There are currently three residents with two staff present. Staffing schedule was reviewed which indicates 24 hour coverage with two staff on duty regularly. A sign in sheet is now present upon entry and utilized. LPA also observed schedules for monthly resident meetings and weekly staff meetings now in place. LPA also observed training certificates in various staff records for mandated reporting and resident rights completed between 7-22-24 and 7-24-24. During today's visit, LPA retrieved copies of LIC 500, daily staff duty checklist, and requested copies of most recent weekly staff meeting notes.

No citations issued today. An exit interview was conducted with S1 and a copy of this report was provided to S1.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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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