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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300522
Report Date: 09/12/2023
Date Signed: 09/12/2023 11:42:03 AM


Document Has Been Signed on 09/12/2023 11:42 AM - 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: 0DATE:
09/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Ann PiersonTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Tung Truong arrived at this facility announced on 9/12/2023 at 11:00 AM to conduct a facility closure visit. LPA met with Business Office Manager Ann Pierson and explained the purpose of the visit.

The purpose of the visit today is in response to the facility closing. LPA Truong toured the facility with Ann Pierson. As of today, all residents have been relocated. LPA observed there were no residents at the facility.

Effective today September 12, 2023, the facility is closed. LPA Truong received the original License. Furthermore, please complete the following closure survey. Link to survey for Facility Closure provided to the facility.www.surveymonkey.com/r/facilityclosure

An exit interview was conducted and a copy of this report was given 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: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
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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