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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005493
Report Date: 02/03/2021
Date Signed: 02/03/2021 03:40:16 PM

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:PARAMOUNT COURT SENIOR LIVINGFACILITY NUMBER:
507005493
ADMINISTRATOR:ANTHONY MONTELLANOFACILITY TYPE:
740
ADDRESS:3791 CROWELL ROADTELEPHONE:
(209) 664-9500
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:100CENSUS: 61DATE:
02/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Anthony MontetelloTIME COMPLETED:
03:00 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
Announced Pre-licensing visit was made by LPA Eric Stone via Facetime on 2/3/2021 with Administrator Anthony Montetello.

The facility will be licensed to serve up to 100 residents at any given time. There were 61 residents in care during today's Pre-licensing visit.

Tour of the facility was conducted via Facetime. The facility has one floor with rooms. There are 10 hospice rooms. There is two dining areas one outside one inside, 3 large activity areas and 1 medication rooms, 2 medication carts and quickmar medical recording, mail cleaning stationand 2 living room. The facility also has a laundry room and 2 janitorial rooms.

A tour via Facetime was conducted of the main care facility. Observed were the 2 different type of bedrooms for residents, kitchen area, dining areas, laundry room and janitorial room were viewed and are in compliance at this time.

The Facility has 1 Medication room that is locked and secured along with the first aid kits. Medication room contained all required components at this time. The facility has 3 fire extinguishers (EXP-8/20/21) placed throughout the facility.

There were no deficiencies observed during today's Pre-licensing visit.
LPA Stone completed Component III requirements with the facility.

Report will be emailed for signature and emailed back to LPA Stone
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Eric StoneTELEPHONE: 916-594-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021
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