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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 032701486
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:34:12 PM

Document Has Been Signed on 02/20/2025 03:34 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LIVEWELL CARE HOME LLCFACILITY NUMBER:
032701486
ADMINISTRATOR/
DIRECTOR:		LI, JONATHANFACILITY TYPE:
735
ADDRESS:290 GOLD STRIKE CTTELEPHONE:
(302) 893-3498
CITY:SUTTER CREEKSTATE: CAZIP CODE:
95685
CAPACITY: 4CENSUS: 4DATE:
02/20/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:09 PM
MET WITH:Karen OrrTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 2/20/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced for a post licensing visit. LPA met with Karen Orr, Administrator and stated the purpose of this visit. There are four residents in care. The facility has completed it's vendorization with VMRC.

LPA toured the physical plant of the facility including the common areas, bathrooms, residents room and garage. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting. LPA observed the following posted in the facility: See Something Say Something complaint poster, Evacuation Routes and facility license were all posted as required.

LPA observed the smoke/monoxide alarms to be in working order, and the fire extinguisher to have been serviced on 2/13/25.

LPA reviewed 1 of 4 resident file and counted resident's money with the administrator and was found to be accurate. 1 of 4 staff files was also reviewed. Per review of Guardian, all 4 staff are associated to this facility. Medications were observed to be in locked cabinet and inaccessible to residents in care.

Licensee was provided technical advisory regarding administrator change and to update resident medical assessments.

No deficiencies are cited during today's inspection.

Exit interview and copy of report provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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