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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209035
Report Date: 07/08/2020
Date Signed: 07/08/2020 11:01:46 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ORCHARD PARK ASSISTED LIVINGFACILITY NUMBER:
107209035
ADMINISTRATOR:FLAHERTY, TRACYFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: 101DATE:
07/08/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tracy FlahertyTIME COMPLETED:
10:30 AM
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On this date, Licensing Program Analyst (LPA) D. Wright conducted a pre-licensing inspection via video conference due to COVID-19. Administrator Tracy Flaherty gave LPA a tour. This facility is currently in operation and has 101 residents. The application is to change ownership. The facility will be ran the same. LPA observed the medication room with three medication carts. The facility has locked cabinets for sharps and cleaning products. Auditory alarms are in place. Required postings are in place. Facility was fire cleared on 01/09/2020 for 148 residents, 128 non-ambulatory and 20 bedridden. Facility conducts fire drills monthly. Smoke and carbon monoxide detectors are installed and operational and the fire extinguisher was serviced. According to water temperature log, hot water temperature measured at 114 F., within range. First aid kits are in place. Tracy's Administrator's certificate is good through 11/15/2021. Component III was not conducted; Administrator has worked in the business for 20 years, and will continue to be the Administrator under the new owners. LPA will email a copy of report to Tracy to sign and send back to LPA. No follow up visit is needed. LPA will contact the Centralized Application Unit to notify facility is in compliance. Facility license pending.
SUPERVISOR'S NAME: Brenda WhiteTELEPHONE: (559) 650-7908
LICENSING EVALUATOR NAME: Dixie Marie WrightTELEPHONE: (559) 772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2020
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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