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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701101
Report Date: 01/26/2022
Date Signed: 01/26/2022 08:47:51 AM

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:PANGO'S CARE HOMEFACILITY NUMBER:
342701101
ADMINISTRATOR:PANG LILY VUEFACILITY TYPE:
740
ADDRESS:34 LOMA MAR CTTELEPHONE:
(916) 508-6319
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 0DATE:
01/26/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:PANG LILY VUETIME COMPLETED:
08:50 AM
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Announced Pre-licensing visit made via to this facility on 01/26/2022, LPA Anthony Tuck was met by the Applicant, Pang Lily Vue. LPA explained the purpose of this additional visit to inspect corrections that were made to deficiencies found on the first pre-licensing visit conducted on 12/22/2021.

LPA inspected hallways and bedrooms. Applicant corrected issues with missing hallway lighting.
LPA inspected bedrooms and all bedrooms contain proper furniture fixtures. LPA inspected wind screens to be repaired. LPA inspected buildings and grounds in backyard. LPA observed all backyard fences to be repaired. LPA observed all pipe and broken sprinkler obstructions to be removed and ground repaired. LPA observed backyard gates to be repaired with latches and pull cords.

Based upon inspection and observations of corrections made at applicants facility location, there were no deficiencies found as of /1/26/2022.

Exit interview conducted with Applicant Pang Lily Vue, a copy of this report was left with the applicant at facility location upon exit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Anthony TuckTELEPHONE: (916) 708-6203
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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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