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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700263
Report Date: 07/03/2023
Date Signed: 07/03/2023 11:58:25 AM

Document Has Been Signed on 07/03/2023 11:58 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:
07/03/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Eunice Ronquillo, AdministratorTIME COMPLETED:
12:15 PM
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On 07/03/2023 at approximately 9:00 am, Licensing Program Analyst(s) (LPA) Renee Campbell and Victoria Brown arrived to conduct an unannounced Legal/Non-Compliance visit at facility. LPAs met with Dimitri Toledano, Administrator and explained the purpose of the visit. Administrator Certificate for Dimitri Toledano expires on 11/14/2024. Licensee(s) Eunice Ronquillo and James Ronquillo, arrived at the facility within 15 minutes. The facility is on a probationary license for 02/24/21- 02/24/24. LPAs observed and reviewed the documents below in the facility.

In-Service Training - Completed 06/26/2023
Fire Drills Procedure.
Facility Sketch Review and Discussion
Emergency and Disaster Drills
Review Emergency Shut Off and Locations

Department of Social Services Survey Binder:
Annual Inspection
LIC 610-D Emergency Disaster Plan
LIC 308 - Designation of Administrator
LIC 309 - Administrative Organization
LIC 500 - Personnel Report
Personal Rights
Activities for each Client
Description of facility and schedule
Stipulation Posted
911 Calling Policy
Emergency Procedures
Incident Reporting
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 392700263
VISIT DATE: 07/03/2023
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LPAs observation:
Smoking signage is suggested for the backyard.
The Personal and Incidental (P&I) binder and procedures were reviewed. Client funds were not co-mingled and a random client's funds were verified.
The required documents were posted and made available for review.
LPA's observed a physical plant log for any maintenance or repairs needed that the licensee is addressing, which is up to date.
LPA's observed two outdoor sheds which were locked and when opened contained yard tools and mattresses wrapped in plastic. Two residents were observed participating in individual activities and 2 were attending day program during this visit.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies cited. Exit interview held, copy of report given
SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
LIC809 (FAS) - (06/04)
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