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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920075
Report Date: 02/13/2025
Date Signed: 02/13/2025 02:12:00 PM

Document Has Been Signed on 02/13/2025 02:12 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:PURE CARE HOMEFACILITY NUMBER:
345920075
ADMINISTRATOR/
DIRECTOR:
MESLOUB, SID ALIFACILITY TYPE:
740
ADDRESS:6355 PERRIN WAYTELEPHONE:
(916) 254-1412
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 6DATE:
02/13/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Licensee/Administrator , Sid Ali MesloubTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 02/13/25 at 01:30PM, an informal conference was conducted at Sacramento Regional Office. The purpose of this informal conference meeting is to discuss issues which were identified during facility’s annual visit on 02/06/25. Present in the meeting is, Licensing Program Manager (LPM) Laura Munoz, Licensing Program Analyst (LPA) Talwinder Bains and Licensee/Administrator, Sid Ali Mesloub. The purpose of the informal conference is to have open discussion related to the current issues at the facility. During this meeting the licensee was made aware that this Informal conference is a part of the Administrative Action process.

The informal conference process was explained during this meeting. Issues discussed during the meeting were:

I. Issues related to Fire Clearance


II. Incomplete Residents Records
III. Recent Deficiencies
IV. Personal Records

To support the facility maintaining substantial compliance with Health and Safety Statute and Title 22 regulations, the Department is developing a plan with the licensee to address causes for concerns. Plan to address compliance concerns by 03/10/25 :

Submission of new LIC308, new LIC500, Completing the pending POC requirements issued on 02/06/25

Administrator was notified that the Department will provide additional case management visits and complete a referral to TSP (Technical Support Program). An exit interview was conducted with administrator. Copy of this report was provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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