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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700619
Report Date: 08/10/2022
Date Signed: 08/10/2022 05:25:55 PM

Document Has Been Signed on 08/10/2022 05:25 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:YELLOW ORCHID LLCFACILITY NUMBER:
342700619
ADMINISTRATOR:BHADE, KIRENDEEPFACILITY TYPE:
740
ADDRESS:9470 SEA CLIFF WAYTELEPHONE:
(916) 432-0685
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 6CENSUS: 6DATE:
08/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Administrator Karen BhadeTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct a required/annual inspection. LPA Lund met with staff who contacted Administrator Karen Bhade who arrived a short time later. Census 6

LPA and Administrator Karen Bhade walked the facility. The physical plant was tour inside and outside to ensure the safety of the residents. All required furniture was observed. LPA observed residents engaging in activity. LPA observed the facility conducts fire drills monthly. All bedrooms contained a dresser, bed, and nightstand. LPA observed the thermostat 74*F temperature inside the facility hallway was measured at 74 *F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C). LPA observed the centrally stored medications area to be locked and inaccessible to clients.

The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility.

LPA observed there were food supplies for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed the backyard area in good condition.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, there were no deficiencies cited during this visit. Exit interview held and a copy of report was given.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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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