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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920075
Report Date: 02/09/2024
Date Signed: 02/09/2024 05:39:19 PM


Document Has Been Signed on 02/09/2024 05:39 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:
02/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:49 PM
MET WITH:Sid MesloubTIME COMPLETED:
05:20 PM
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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. Areas toured included but not limited to: resident bedrooms, caregiver room, bathrooms, laundry room, kitchen and common areas. LPA observed all six resident bedrooms to have the proper furniture. LPA observed the locked storage space for knives, medications and toxins. LPA observed facility to have the appropriate postage in the hallway. LPA observed facility to have fire extinguishers, operable fire alarm and carbon monoxide present.

LPA conducted a tour in the exterior and observe the pool to be locked and inaccessible. LPA and Applicant discussed ensuring the pool gate is locked at all times.

LPA informed Applicant LPA will email Applicant a copy of Health and Safety Code for staff training and LIC 311F File Checklist.

Today's inspection, LPA and Applicant completed Comp III and no corrections are needed. LPA informed Applicant LPA will notify CAB of prelicensing completion.

Exit interview conducted and a copy of the report was emailed.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024
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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