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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005738
Report Date: 03/14/2025
Date Signed: 03/14/2025 03:04:03 PM

Document Has Been Signed on 03/14/2025 03:04 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: 0DATE:
03/14/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:William PuckettTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 3-14-25 at 1:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived to conduct a quarterly health and safety visit and address annual fees due. LPA met with Licensee William Puckett and explained the purpose of the visit. Facility does not have any clients or staff at this time. LPA conducted facility observation during today's visit. LPA observed facility to be empty of clients and staff. Facility was clean and sanitary with furnishings in place located in common areas and bedrooms. All postings for resident rights, disaster plan, infection control plan, license, and Administrator certificate were observed. Fire extinguisher is in place and fully charged. No expired food noted during today's visit. Facility temperature is 70*F.

Presently, the facility has an outstanding balance of $1362.00. On 10/2/2024, Community Care Licensing Division (CCLD) sent a bill with the annual licensing fees to the Licensee; however, the annual fees have not been paid as of this date. LPA informed and explained to Licensee per (CCLD) regulations regarding Licensing Fees - The failure of an applicant or licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. In an effort to assist Licensee with a quicker method of payment, LPA advised Licensee to pay fees online at CCLD website http://www.ccld.ca.gov/.

No citation issued today, however, the following advisory was given: Please pay the Annual Licensing Fees to prevent further action. This is not a citation but an advisory. Administrator agreed to pay fees on or by 3/31/2025.

An exit interview was conducted. A copy of this report was provided to Licensee.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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