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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700995
Report Date: 05/19/2021
Date Signed: 05/19/2021 02:24:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:PEARL CARE ASSISTED LIVINGFACILITY NUMBER:
342700995
ADMINISTRATOR:DANILIUC, DORINFACILITY TYPE:
740
ADDRESS:8523 WINDINGWAYTELEPHONE:
(916) 256-9400
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6; 6; 6CENSUS: 0DATE:
05/19/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Applicant, Dorin DaniliucTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Melana Llopis contacted the facility via tele-visit on 05/19/2021 to follow up on a pre licensing inspection conducted 04/28/2021. LPA met with applicant, Dorin Daniliuc and reviewed the purpose of today's visit.

During the inspection on 04/28/2021 the following issues needed to be corrected:
  • Due to home improvements, resident rooms were storing applicant's personal belongings.



During today's visit LPA observed the above issues were addressed and corrected.
  • Resident rooms are cleared of applicant's belongings.
  • Resident rooms are move in ready.



Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulations.
Component III was completed during visit. LPA will notify the Centralized Application Bureau (CAB) of the applicant's current status.

Exit interview conducted and copy of report provided. Applicant to send a signed copy to CCL by 05/20/2021.
SUPERVISOR'S NAME: Kevin MknellyTELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Melana LlopisTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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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