<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700263
Report Date: 02/15/2023
Date Signed: 02/15/2023 05:26:57 PM

Document Has Been Signed on 02/15/2023 05:26 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:PIONEER CARE HOMEFACILITY NUMBER:
392700263
ADMINISTRATOR:RONQUILLO, EUNICEFACILITY TYPE:
735
ADDRESS:9474 PIONEER CIRCLETELEPHONE:
(209) 910-9014
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 6CENSUS: 4DATE:
02/15/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Eunice and James RonquilloTIME COMPLETED:
05:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/15/23 at approximately 3pm, Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a quarterly health and safety check. LPA Jensen met with Eunice Ronquillo and explained the purpose of today's visit.

Based on interviews with Eunice and James Ronquillo, and a review of the Administrator certificates, the Administrator's certificate for Eunice Ronquillo # 6035356735 expires today, request for renewal has not been submitted to date. The Administrator certificate for James Ronquillo # 6035699735 expires 2/21/23, request for renewal has not been sent to date. The facility does have a designation of facility responsibility on file for a staff member (S1) who holds an active certification through 11/14/24.

LPA Jensen reviewed staff files for 8 of 8 staff members. Each staff member has "Direct Care Staff Orientation and Training Checklist" however there is no written plan for the orientation, continuing education, on-the-job training and development, supervision, and evaluation of all direct care staff. In addition 2 of 8 staff members lacked documentation indicating that a minimum of 8 hours had been completed within the last year.

Deficiencies are being cited from the California Code Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.

An exit interview was conducted and a copy of this report was given to Eunice Ronquillo.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/15/2023 05:26 PM - It Cannot Be Edited


Created By: Maja Jensen On 02/15/2023 at 05:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: PIONEER CARE HOME
FACILITY NUMBER: 392700263

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2023
Section Cited
CCR
82065.1(d)

1
2
3
4
5
6
7
Personnel Qualifications and Duties
The licensee shall develop,maintain, and implement a written plan for the orientation, continuing education, on-the-job training and development, supervision, and evaluation of all direct care staff. This requirement was not as evidenced by:

(1) Direct care staff shall receive a minimum of 8 hours a year of training, documented.
1
2
3
4
5
6
7
Licensee agrees to submit a plan via email to maja.jensen@dss.ca.gov for compliance with this regulation by the POC due date and submit proof that staff have completed at least 8 hours of training within the last 12 months-See staff reference #1 and 3.
8
9
10
11
12
13
14
Based on staff record reviews and an interview with Administrator Eunice Ronquillo the facility has no formal written plan to ensure compliance with CCR 82065.1(d)
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Liza King
LICENSING EVALUATOR NAME:Maja Jensen
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2