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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700263
Report Date: 04/11/2023
Date Signed: 04/11/2023 11:18:36 AM

Document Has Been Signed on 04/11/2023 11:18 AM - 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 AC/SC, 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:
04/11/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Dimitri Toledano, AdministratorTIME COMPLETED:
11:30 AM
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At 9 am,on 04/11/2023 Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a quarterly facility inspections. LPA Campbell was first greeted by Dimitri Toledano (#6064335735), Administrator, and LPA explained the purpose of the visit. Licensees, Eunice and James Ronquillo later arrived as well.

LPA Campbell inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, common areas, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a 4 bedroom Adult Residential Facility with a current census of 4. which licensee has decided to maintain. One room is used as an office. LPA was screened upon entry for temperature. All knives, toxins, and other chemicals were inaccessible to residents in care. Resident rights posted. No obstructions to emergency exits noted.

The facility has a central entry point and has implemented screening and sign in procedures at the front door area. LPA observed the facility to have hand washing signs posted in the facility and on front door. Common touch surfaces are cleaned after each use. LPA observed all staff to be wearing masks during visit. LPA informed licensee of the change in masking guidelines and they have decided to have staff continue to wear masks.. LPA Campbell observed facility to be clean and sanitary with no foul odors or items in disrepair noted. . LPA reviewed 3 of 4 resdient charts and 3 of 6 staff charts. Staff files contained required initial staff training and other contents. LPA observed 2 days of perishables and 7 days of non-perishable food items.

During inspection, LPA Campbell observed three clients in the facility. One resident watched TV in the living room and the other two residents were engaging with staff off and on. One resident was at his day program.
No deficiencies were cited, pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview held, copy of report given.
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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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