<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701371
Report Date: 08/13/2024
Date Signed: 08/13/2024 12:40:35 PM

Document Has Been Signed on 08/13/2024 12:40 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:
08/13/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Latrice Gonzalez TIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 08/13/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to conduct a pre-licensing visit. LPA met with applicant, Latrice Gonzalez and explained the purpose of the visit. The purpose of this visit was to conduct a pre-licensing visit.
This facility is intended to serve and retain residents from Valley Mountain Regional Center. This facility is awaiting vendorization from VMRC to retain Level 3 residents at this time. This facility must also hold 6 ambulatory residents.
A brief interview was conducted with Applicant, Latrice Gonzalez.
Current census was 0 residents.
Tour of the facility was conducted.
The fire extinguisher, located in the front hallway, was purchased with a receipt attached and purchased on 07/31/2024. All smoke detectors were present and working at this time.
Four resident bedrooms were toured. Furniture and furnishing were observed to be present and in good condition. An office was toured and was observed to be in good repair.
Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.
A linen closet was located in the hallway. LPAs observed a sufficient amount of linens at this time.
A tour of the bathrooms was conducted. Hot water temperatures were taken to ensure that the hot water being dispensed was within the allowed range of 105-120 degrees at all times.
The kitchen area was toured. Facility freezer and refrigerator showed to be functional and in compliance at this time. LPAs observed that there was a sufficient amount of 2-day perishable and 7-day nonperishable food supplies available at this time.
Garage area was toured. LPAs observed a refrigerator which will store additional food supplies. Additional storage for supplies were stored in cabinets.
This facility will be using a medication cabinet which was located in the living room. LPAs observed the medication cabinet to be locked and made inaccessible at this time.
First aid kit was observed to be present and contained all of the required components at this time.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 LLC
FACILITY NUMBER: 502701371
VISIT DATE: 08/13/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and in compliance at this time.
Exterior grounds of this facility was toured. Perimeter fence and gates were checked and presented no hazards at this time.

This facility has been observed to be in compliance at this time.
There were no deficiencies observed during the course of this Pre-licensing visit.

Applicant has already conducted Comp I and Comp II.
Comp III was reviewed with applicant.

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: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2