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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700342
Report Date: 11/08/2023
Date Signed: 11/09/2023 12:23:58 PM


Document Has Been Signed on 11/09/2023 12:23 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 5DATE:
11/08/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Tahiri PalominoTIME COMPLETED:
02:00 PM
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Licensing Program Analyst Jason Lund arrived unannounced to conduct an proof of correction visit. LPA met with Administrator Tahiri Palomino and explained the reason for the visit. Census: 5

Administrator Jenna Pamittan finished has taken take a vendor approved course pertaining to Ethic, leadership/management and turned it into to licensing. This is from the office visit on 11/30/2022.


No deficiencies were cited during the visit. Exit interview conducted and copy of report given.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Jason LundTELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
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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