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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 572700714
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:42:33 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/05/2024 03:42 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CAREWELL AT PISTACHIO LLCFACILITY NUMBER:
572700714
ADMINISTRATOR:PANTIG, PAULINFACILITY TYPE:
740
ADDRESS:1125 PISTACHIO COURTTELEPHONE:
(530) 759-2060
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 6CENSUS: 6DATE:
03/05/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Paulin Pantig, House ManagerTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Stefanie Mutialu and Jill Nakagawa arrived unannounced to continue a 1-Year Annual Inspection. This visit focused on the review of the Personnel Files. Five out of five files were reviewed and found to be complete with adequate training documented.

The facility was clean and a comfortable temperature. The interior of the facility had recently been painted. There were no paint fumes to impact residents. New lighting had been installed in the resident bedrooms, providing nice bright light and the comforts of ceiling fans.

There were no deficiencies found at the time of inspection.
No citations issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
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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