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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 176803831
Report Date: 03/11/2025
Date Signed: 03/11/2025 11:06:14 AM

Document Has Been Signed on 03/11/2025 11:06 AM - 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:ORCHARD PARK SENIOR LIVING COMMUNITYFACILITY NUMBER:
176803831
ADMINISTRATOR/
DIRECTOR:		JONES, MELISSAFACILITY TYPE:
740
ADDRESS:14789 BURNS VALLEY ROADTELEPHONE:
(707) 995-1900
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY: 56TOTAL ENROLLED CHILDREN: 0CENSUS: 30DATE:
03/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Melissa Jones, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct a Case Management Inspection and met with Administrator Melissa Jones. The purpose of this case management inspection is to follow up on an SOC 341 submitted to Community Care Licensing (CCL).

On 2/11/2025 CCL received an SOC341 from facility reporting financial abuse on 2/10/2025.

During today’s inspection LPA conducted interviews and obtained records. LPA will review information, conduct additional interviews and follow up with facility.

No citation issued during today’s visit.

Bethany MoellersTELEPHONE: (707) 588-5026
Shannan HansenTELEPHONE: 707-588-5026
DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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