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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701371
Report Date: 06/27/2024
Date Signed: 06/27/2024 12:56:33 PM

Document Has Been Signed on 06/27/2024 12:56 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:WE ARE THE VILLAGE LLCFACILITY NUMBER:
502701371
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, LATRICEFACILITY TYPE:
735
ADDRESS:2205 SUNNY ISLAND CTTELEPHONE:
(209) 271-2912
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY: 6CENSUS: 0DATE:
06/27/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:03 AM
MET WITH:Latrice GonzalezTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 06/27/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to conduct a reinspection pre-licensing inspection. LPA met with applicant, Latrice Gonzalez and explained the purpose of the visit.

The purpose of this visit was to re-inspect resident bedrooms to reflect that the facility is move in ready for residents in care, in addition, all knives, toxins, laundry supplies, cleaning supplies, and medication was to be locked and made inaccessible to residents in care.

LPA observed the following items during this visit.
LPA observed hair products, mouthwash, other hygiene items and medications accessible on the drawers in the bathrooms. LPA observed personal clothing in dresser drawer. In addition, all resident rooms still have personal items.

Based on the observations made during the course of this visit, the applicant has not passed this pre-licensing visit.

This Pre-Licensing is incomplete with deficiencies to be resolved. A follow up Pre-licensure visit will be conducted upon resolution of deficiencies.

An exit interview was conducted and a copy of this report was provided to the applicant at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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