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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097004177
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:32:09 PM

Document Has Been Signed on 02/05/2025 01:32 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PONTE PALMEROFACILITY NUMBER:
097004177
ADMINISTRATOR/
DIRECTOR:		PILEGAARD, LANDONFACILITY TYPE:
740
ADDRESS:3083 PONTE MORINO DRIVETELEPHONE:
(530) 677-9100
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY: 250TOTAL ENROLLED CHILDREN: 0CENSUS: 173DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Assisted Living Director Jennifer HinchTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Lavinia Muscan and Talwinder Bains arrived on 2/5/2025 to conduct the annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPAs reviewed ten resident (10) and ten staff (10) files. All residents files contained the required paperwork. All staff files contained the required paperwork and training.

LPA and Assisted Living Director Jennifer Hinch toured the facility together to ensure the health and safety of residents in care. The areas toured included resident apartments, kitchen, hallways, memory care apartments, memory care dining room/kitchen, and memory care common areas. Water temperatures in the apartments toured were within the required range of temperature. In the areas toured, there were no health or safety violations observed.

LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by end of the month.

Exit interview conducted. A copy of this report was printed and given to Staff.
Laura MunozTELEPHONE: (916) 263-4743
Lavinia MuscanTELEPHONE: 916-263-4700
DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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