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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
502700342
Report Date:
06/13/2024
Date Signed:
06/13/2024 02:55:50 PM
Document Has Been Signed on
06/13/2024 02:55 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 LLC
FACILITY NUMBER:
502700342
ADMINISTRATOR:
PAMITTAN, JEANNA
FACILITY TYPE:
740
ADDRESS:
142 PALOMINO WAY
TELEPHONE:
(650) 477-8065
CITY:
PATTERSON
STATE:
CA
ZIP CODE:
95363
CAPACITY:
6
CENSUS:
6
DATE:
06/13/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:15 PM
MET WITH:
Administrator Jeanna Pamittan
TIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst Jason Lund arrived unannounced to conduct case management visit. LPA met with Administrator
Jeanna Pamittan
and explained the reason for the visit. Census: 6
LPA Lund reviewed three residents’ medications to ensure compliance. LPA Lund observed the three residents’ medications files to be in compliance at this time.
No deficiencies were cited during the visit. Exit interview conducted and copy of report given
.
SUPERVISOR'S NAME:
Lisa Rios
TELEPHONE:
(916) 969-9685
LICENSING EVALUATOR NAME:
Jason Lund
TELEPHONE:
(916) 223-6752
LICENSING EVALUATOR SIGNATURE:
DATE:
06/13/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/13/2024
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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