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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700342
Report Date: 11/03/2021
Date Signed: 11/04/2021 08:32:06 AM

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:PATTERSON CAREHOME LLCFACILITY NUMBER:
502700342
ADMINISTRATOR:PAMITTAN, JEANNAFACILITY TYPE:
740
ADDRESS:142 PALOMINO WAYTELEPHONE:
(650) 477-8065
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY:6CENSUS: 3DATE:
11/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administratro Jeanna PamittanTIME COMPLETED:
12:30 PM
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Licensing Program Analyst Jason Lund made an unannounced visit and met with Licensee Jenna Pamittan to conduct a required annual inspection. Administrator Certification for Jeanna Pamittan # 6042254740 expires 12/3/22.

There are currently 3 residents in the facility currently has one resident on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, a sample of resident bedrooms and bathrooms, garage and outside areas, dining room and kitchen. Bathrooms and bedrooms were clean and in good repair. LPA observed an adequate amount of linens. Facility's exit was unlocked. There is a locked storage for medications and toxins and all medications were locked. Smoke alarm system is built into the facility. Facility has fire extinguishers that were serviced in March 2021. All four staff are fully vaccinated


No deficiencies were cited during the visit. Exit interview conducted and copy of report given.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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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