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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300522
Report Date: 01/12/2022
Date Signed: 01/12/2022 03:34:51 PM

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:DAVID SHELLHAMERFACILITY TYPE:
740
ADDRESS:415 P STREETTELEPHONE:
(916) 442-4906
CITY:SACRAMENTOSTATE: CAZIP CODE:
95814
CAPACITY:41CENSUS: 12DATE:
01/12/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:David Shellhamer, AdministratorTIME COMPLETED:
03:40 PM
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On 1/12/2022 at 2:50 pm, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct a proof of correction (POC) visit in regard to deficiencies cited on 1/06/2022. LPA met with Administrator David Shellhamer and explained the purpose of today’s visit.

LPA observed the water temperature in room #218 is 110.3 degrees Fahrenheit, room #220 is 109.6 degrees Fahrenheit and room #318 is 109.8 degrees Fahrenheit.



*Deficiency cited under Title 22 Regulation 87303(e)(2) – Cleared. Proof of correction was submitted on 1/06/2022. Licensee complied with the terms of the POC by POC due date.

Facility was provided POC cleared letter.

Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
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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