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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005738
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:31:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/23/2024 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20240823100640
FACILITY NAME:INSPIRING CAREFACILITY NUMBER:
397005738
ADMINISTRATOR:WILLIAM PUCKETTFACILITY TYPE:
735
ADDRESS:2488 NATHANIEL STREETTELEPHONE:
(209) 951-2405
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:5CENSUS: 3DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:William PuckettTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff allowed unfingerprinted boyfriend to come to facility while residents were there
INVESTIGATION FINDINGS:
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On 8-28-24 at 2:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate the complaint allegation noted above. LPA met with Administrator William Puckett and explained the purpose of the visit. During this investigation, LPA conducted interview with Administrator and reviewed incident report dated 5/29/24. Based on interview and record review, it was determined that on 5/28/24 at approximately 2:00am, facility Administrator and House Manager performed a random shift audit for the night shift and discovered that the NOC staff member (S1) had allowed an unauthorized person to enter the facility has her guest and utilize facility premises including sleeping on premises. Administrator contacted local police department for assistance resulting in the unauthrorized person's departure.

As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6 and noted on LIC 9099D. An exit interview was conducted with William Puckett and a copy of this report was provided to William. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 27-AS-20240823100640
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: INSPIRING CARE
FACILITY NUMBER: 397005738
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2024
Section Cited
CCR
80072(a)(2)
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Personal Rights. (a) Except for children’s residential facilities, each client shall have personal rights which include...(2) To be accorded safe, healthful and comfortable accommodations...This requirement was not met as evidenced by:
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Licensee will read regulation 80072(a)(2) and submit a signed declaration of understanding to LPA by POC due date.

Licensee will develop a plan to ensure unauthroized pesons are not allowed in facility. Plan to be submitted to LPA by POC due date.
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Based on interview and record review, Licensee did not ensure the compliance with regulation above in that an unauthorized individual was allowed by staff to enter facility and utilze premises. This posed a potential health, safety, and resident rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
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