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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315001878
Report Date: 12/18/2020
Date Signed: 12/18/2020 01:35:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LONG CREEK CARE HOMEFACILITY NUMBER:
315001878
ADMINISTRATOR:SORIANO, ORLANDOFACILITY TYPE:
740
ADDRESS:1415 LONG CREEK WAYTELEPHONE:
(916) 772-6224
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 4DATE:
12/18/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Orlando SorianoTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Kerry Hiratuska, Licensing Program Manager (LPM) Troy Ordonez, and Acting Regional Manager (ARM) Laura Munoz, contacted the facility via WEBEX to review the Stipulation and Waiver; and Order on 12/11/2020 due to COVID-19 and pre-cautionary measures. LPA, LPM, and ARM identified themselves and discussed the purpose of the call with Licensee/Administrator Orlando Soriano, Licensee's attorney Michael Levin, and Applicant Danelle Soriano.
LPA reviewed the Stipulation and Waiver; and Order with Mr. Soriano, Mr. Levin, and Ms. Soriano which highlighted the following components:


The Stipulation and Waiver; and Order:
Revocation of License: Respondents Orlando Soriano license is revoked upon the Department's adoption of this Stipulation as its Order. in order to provide a timely notice to each client, and to facilitate the sale or transfer of the facility, revocation of Respondent's license shall be stayed for a period of 90 days following adoption of this Stipulation.
60-day written notices
Within 24 hours of the date that Respondent receives the Order adopting this Stipulation, Respondent shall give a 60-day written notice to each client and to each client's responsible party that Respondent may no longer provide care and supervision after the closure date and that all clients who require care and supervision will be required to relocate if Respondent is unable to complete a sale or transfer of the facility.
Additionally, Respondent shall include in the written notice information regarding the pending sale or transfer. If Respondent is unable to complete the pending sale or transfer of the facility, Respondent shall cooperate with appropriate agencies as necessary to assist with the relocation of such clients. Respondent shall submit a copy of such written notice to the Department at its licensing office located at 2525 Natomas Park Drive, Suite 270, Sacramento, CA 95833, by Saturday, December 19, 2020.

SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: LONG CREEK CARE HOME
FACILITY NUMBER: 315001878
VISIT DATE: 12/18/2020
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Respondent shall assist clients who have no relatives or responsible parties in contacting community resources that can arrange for a new placement, if necessary. Respondent shall not solicit, request, or accept fees, payments or gratuities from clients, their relatives or responsible parties or placing agencies for any placement assistance or referrals by Respondent to a new facility Respondent shall forward to the Department a list of all clients who have been served with the notice to relocate, as well as the name, address, and telephone number of the place to which each client has been relocated.

Revocation of Administrator Certificate: Respondent's administrator certificate is revoked upon the adoption of this Stipulation and Order. It shall be Stayed to facilitate the sale or transfer of this order. Upon completion of the sale or transfer of the facility, Respondent's administrator certification shall be revoked for the remainder of Respondent's life.

Prohibited employment and other positions in licensed facility: Respondent is excluded from being a licensee, owning a beneficial ownership interest of 10 person or more in a licensed facility, or being an administrator, director, member, or manager of a licensee or entity controlling a licensee, and further from employment in a licensed facility licensed by the Department, for a period of two years from the effective date of the Order adopting this Stipulation, with the exception that Respondent is permitted to be present and employed at the facility during the stay of the license revocation as specified in paragraph 2 of the Stipulation.
Respondent is permitted to reside in, and have contact with the clients of, the residential care facility for the elderly located at 1415 Long Creek Way, Roseville, CA for the period of two years from the effective date of adopting this Stipulation. Respondent shall not provide any direct care and supervision.

Due to COVID 19 restrictions, LPA Hiratsuka, is emailing a copy of this report to Licensee for review and and his signature on the hard copy. Licensee is to review, print out the report, sign the hard copy, scan, and email it to LPA. LPA is also going to email a copy of this report to Licensee's attorney at Licensee's request.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
LIC809 (FAS) - (06/04)
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