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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300522
Report Date: 08/01/2023
Date Signed: 08/01/2023 12:13:23 PM


Document Has Been Signed on 08/01/2023 12:13 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:PIONEER HOUSEFACILITY NUMBER:
340300522
ADMINISTRATOR:FRAZIER, KAYLAFACILITY TYPE:
740
ADDRESS:415 P STREETTELEPHONE:
(916) 442-4906
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:41CENSUS: 5DATE:
08/01/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Ann PiersonTIME COMPLETED:
12:30 PM
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On 8/1/23, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct a health and safety check. LPA met with Business Office Manager Ann Pierson and explained the purpose of the visit.

LPA toured and inspected the physical plant inside to ensure compliance with Title 22 regulations.

On 7/18/2023, the licensee notified the Department that the facility is not economically viable and that the licensee has decided to close. There are only five residents currently living in the facility which all have been given 60-day notices.

LPA observed the facility to be clean and sanitary. LPA observed an adequate supply of food for 5 residents. The temperature inside was set to 68 degrees Fahrenheit, which is within the required range of 68-85*F.

No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.

Exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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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