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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001891
Report Date: 12/30/2024
Date Signed: 12/30/2024 02:15:03 PM

Document Has Been Signed on 12/30/2024 02:15 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:LIFE PASTICHEFACILITY NUMBER:
455001891
ADMINISTRATOR/
DIRECTOR:
JOHNSON, RHONDAFACILITY TYPE:
740
ADDRESS:19323 HOLLOW LANETELEPHONE:
(530) 215-1685
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Facility Manager, Christian FisherTIME VISIT/
INSPECTION COMPLETED:
02:30 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 December 30, 2024 at approximately 1:30 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Life Pastiche for the purpose of conducting a Case Management-Incident inspection. LPA Was greeted at the door by Facility Manager, Christian Fisher, and was granted access into the facility.

During the Case Management-Incident inspection, LPA reviewed the Incident Report that was forwarded to Community Care Licensing Division (CCLD). LPA learned that a medication went missing during evening medication passes (See LIC 9102-Technical Violation). Facility reported this incident to the appropriate parties. LPA conducted a tour of the facility with the Facility Manager. LPA observed the facility to be clean with all exits free from obstruction. LPA observed the medication room where medications are dispensed and found that the medication room was locked and secured. LPA observed sufficient perishable and non-perishable foods located in the kitchen. LPA educated the Facility Manager regarding the importance of ensuring that ALL medications are centrally stored and locked as outlined in Title 22 regulations. In addition, LPA advised that if another incident of this nature occurs again, a citation would be issued to the facility. LPA discussed the Title 22 Regulation with the Facility Manager. Facility Manager understood the Title 22 Regulation.

No deficiencies were cited during today's Case Management-Incident Inspection. LIC 9102-Technical Violation was issued to the facility today. Exit interview was conducted, and a copy of this report was signed and emailed to the Facility Manager due to printer issues.
Lauren CrockerTELEPHONE: (916) 202-0832
Farhaan SarangiTELEPHONE: (916) 307-0474
DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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 1