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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920075
Report Date: 03/18/2025
Date Signed: 03/18/2025 01:20:42 PM

Document Has Been Signed on 03/18/2025 01:20 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:
03/18/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Licensee/Administrator , Sid Ali MesloubTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On 03/18/25, Licensing Program Analyst (LPA) Talwinder Bains conducted an unannounced visit for the purpose of a Plan of Corrections visit (POC's) that were issued during annual facility visit on 02/06/25.

LPA met with Licensee/Administrator , Sid Ali Mesloub and explained the purpose of the visit. During today's visit, LPA observed fire extinguisher was serviced on 02/07/25 and was ready for emergency use. LPA audited all 6 residents files and found out that all residents were listed as Ambulatory or Non-ambulatory on thier Fire Clearance sections in their medical assessment (LIC602) per their physicians which was in compliance with facility's current 'Fire Clearance Status'. Staff files audit indicated that all current staff has required Physical Exam and TB test .

Based on gathered information. all citations issued on 02/06/25 were cleared during today's visit as facility fulfilled the POC requirements .

No citations were issued during this visit. Exit interview conducted with administrator.


Copy of this report has provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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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