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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700263
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:17:48 PM

Document Has Been Signed on 10/26/2022 12:17 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:
10/26/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Eunice RonquilloTIME COMPLETED:
12:15 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 10/26/2022 at 10:24 AM, Licensing Program Analyst (LPA) Michael Bilger conducted an unannounced Legal/Non-Compliance visit at facility. LPA met with Licensee/Administrator, Eunice Ronquillo and explained the purpose of visit. The facility is on a three year probation and will have increased unannounced monitoring.

LPA reviewed the following documents:

In-Service Training
Fire Drills - 7-15-22, 8-27-22. Facility Sketch Review and Discussion
Emergency and Disaster Drills - 8-27-22, 9/11/22. Review Emergency Shut Off and Locations

Department of Social Services Survey Binder:
02/11/2022 Annual Inspection
Current LIC 610-D Emergency Disaster Plan 03/06/2022
LIC 308 - Designation of Administrator - 04/06/2022
LIC 309 - Administrative Organization - 05/01/2022
LIC 500 - Personnel Report - LPA requested updated form to be sent by 10/28/22.
Personal Rights
Activities for each Client
Description of facility and schedule
Copy of Stipulation - 2/24/21
911 Calling Policy
Emergency Procedures
Incident Reporting
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 392700263
VISIT DATE: 10/26/2022
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
26
27
28
29
30
31
32
Department of Social Services Survey Binder:
Non-Compliance Conference 11/14/2019

Compliance Binder:
Personal Rights
Technical Support Program Engagement Summary - 4/12/21

Staff In-Service Training
Observations of clients, when to obtain medical emergency for a client, duty of independent caregivers for obtaining emergency care for clients, abuse training, mandated reporting requirements, and personal rights. Demonstration, SIR reporting, Unusual Incidents, Discussion, Scenarios, Questions and Answers, and Examinations. 3/7/21 (8:30 AM - 9:30 AM, 9:30 AM - 10:30 AM,10:30 AM - 11:30 AM), 4/24/2021 (3:30 PM - 4:30 PM), 4/25/21 (11:00 AM - 11:30 AM, 3:00 PM - 3:30 PM, 3:30 PM - 4:30 PM), 5/23/21 (4:00 PM - 5:00 PM), and 6/25/21 (2:30 PM - 3:30 PM) 07/23/2021 (3:00 PM - 4:00 PM) 08/27/2021 (10:00 AM- 11:00 AM) 09/25/2021 (2:00 PM - 3:00 PM) 10/25/2021 (3:00PM- 4:00PM) 11/25/2021 (10:00 AM- 11:00 AM) 12/26/2021 (1:00 PM- 2:00 PM) 01/23/2022 (10:00 AM-11:00 AM) 02/25/2022 (3:00 PM- 4:00 PM) 03/7/2022 (11:00 AM - 11:30 AM) 04/27/2022 (3:00 PM- 4:00 PM) 05/25/2022 (9:00 AM- 9:30 AM) 06/26/2022 (2:00 PM - 2:30 PM), 7-22-22 (3:00pm-3:30pm), 7-23-22 (3:00pm-4:00pm), 8-25-22 (1:00pm-2:00pm), 8-27-22 (10:00am-11:00am), 9-24-22 (3:00pm-4:00pm), 9-25-22 (2:00-3:00pm)

LPA observed common areas, kitchen area, resident bedrooms, and outside area to ensure compliance with Title 22 regulations. LPA observed adequate food supply. Facility was clean and sanitary. Floors and walls were clean and no foul odors observed. Water temperature measured between 105*F and 120*F. Fire extinguisher lasted dated 7-28-22. Room temperature was at 71*F. No obstruction to fire exits noted.

No deficiencies cited on today's date.

Exit interview with Licensee/Administrator and copy of report given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2