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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920075
Report Date: 02/01/2024
Date Signed: 02/01/2024 04:50:24 PM


Document Has Been Signed on 02/01/2024 04:50 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:PURE CARE HOMEFACILITY NUMBER:
345920075
ADMINISTRATOR:MESLOUB, SID ALIFACILITY TYPE:
740
ADDRESS:6355 PERRIN WAYTELEPHONE:
(916) 254-1412
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 0DATE:
02/01/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Sid MesloubTIME COMPLETED:
04:20 PM
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On 02/01/2024, Licensing Program Analyst (LPA) Cassie Yang arrived to the facility to conduct a Pre-Licensing inspection. LPA met with applicant, Sid Mesloub, and explained the purpose of the visit.

During today's inspection, LPA and Applicant conducted a tour of the interior and exterior of the facility. LPA observed Applicant to be in the middle of getting the facility ready as LPA observed multiple corrections needed. LPA informed Applicant another pre-licensing inspection will be conducted on Friday February 9, 2024 at 3:00PM.

Exit interview conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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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