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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209035
Report Date: 03/30/2021
Date Signed: 03/30/2021 11:13:25 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: 106DATE:
03/30/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Administrator, Tracy FlahertyTIME COMPLETED:
11:20 AM
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On 3/30/2021, Licensing Program Analyst (LPA) A. Walton contacted Administrator, Tracy Flaherty to conduct a Case Management visit via telephone due to COVID-19 and precautionary measures. The purpose of today's visit is to follow up on an incident report submitted to the Fresno CCL office.

On 3/24/2021, it was reported that R1 had money stolen from R1's apartment by facility staff.

LPA is requesting the following documents be submitted to the Fresno CCL office by 4/02/2021: Resident R1 records and a copy of the video.

No deficiencies issued.

Exit interview conducted with Administrator. A copy of this report was provided to Administrator, Tracy Flaherty via email and an electronic read receipt confirms receiving these documents. Facility Representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021
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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