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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700342
Report Date: 10/31/2024
Date Signed: 11/03/2024 04:04:33 PM

Document Has Been Signed on 11/03/2024 04:04 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/
DIRECTOR:
PAMITTAN, JEANNAFACILITY TYPE:
740
ADDRESS:142 PALOMINO WAYTELEPHONE:
(650) 477-8065
CITY:PATTERSONSTATE: CAZIP CODE:
95363
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator Tahiri Palomino TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst Jason Lund arrived unannounced to conduct an annual/required inspection. LPA met with Administrator Tahiri Palomino and explained the reason for the visit. Census: 6

LPA Lund & Administrator Tahiri Palomino toured/inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven-day nonperishable and two-day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications. LPA reviewed and compared resident medication vs. resident medication logs. Fire drill was completed on 10/4/2024. Fire extinguishers (10/10/2024) & carbon monoxide detector are incompliance. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and complete. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 2 resident and 2 staff files and were in compliance.

No deficiencies were cited during the visit. Exit interview conducted and copy of report given.
Lisa RiosTELEPHONE: (916) 969-9685
Jason LundTELEPHONE: (916) 223-6752
DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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