342701385-4-29-2024-27-AS-KVIA-D4SPK2-20240429112226

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701385
Report Date: 04/29/2024
Date Signed: 04/29/2024 11:23:14 AM

Document Has Been Signed on 04/29/2024 11:23 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	ORANGE ORCHARD HOME		FACILITY NUMBER:	342701385
ADMINISTRATOR/ DIRECTOR:	NAVARRO, FLORDELIZA		FACILITY TYPE:	735
ADDRESS:	12268 HABITAT WAY		TELEPHONE:	(916) 693-5088
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95742
CAPACITY: 4		CENSUS: 0	DATE:	04/29/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	FLORDELIZA NAVARRO		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/29/24, an unannounced pre-licensing Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility. LPA identified herself, explained the purpose of the visit, and asked to speak with Licensee/Designated Facility Administrator (DFA). LPA met with Flordeliza Navarro and a brief interview and tour followed. At the present time, there were no residents in care. DFA's certificate, # 6002544735 expires on 08/19/24. The inspection began in the kitchen. All knives and sharps were locked and inaccessible to future residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. Opened packages in the refrigerator were dated appropriately. Toxic cleansers were locked in a cabinet under the sink. LPA inspected the 4 resident bedrooms and 2 bathrooms. All resident rooms had the required furniture, furnishings and lighting to be in compliance at this time. LPA noted soap, paper towels and trash cans with lids in the bathrooms. The hot water temperature was measured at 105.2 degrees Fahrenheit and was in compliance. The fire extinguisher was last serviced on 01/03/24 by Sentinel Fire Equipment Fire Co. and was also in compliance. The LPA observed a locked cabinet in the living room where medications for future residents will be stored. and kept inaccessible to residents in care. LPA reviewed storage, dosing, and destruction procedures. A review of the First Aid kit by the LPA found it to be complete and in compliance. LPA inspected the garage next. LPA observed a freezer and small refrigerator for staff food storage. There were large shelving units on both sides of the garage where holiday decorations and other household items were stored. The garage was free of debris and clutter at this time.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ORANGE ORCHARD HOME	FACILITY NUMBER: 342701385
	VISIT DATE: 04/29/2024

NARRATIVE

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LPA reviewed the facility, staff, and resident binders prepared for new hires and future clients. Each had tabs for the documents required by Community Care Licensing.

LPA observed appropriate signage: See Something Say Something, Resident Rights, Facility Sketch, Emergency Preparedness Plan, Emergency Phone Numbers, Staff Schedule, and Sample Menu.

The exterior of the building was inspected by the LPA. There were no bodies of water present and the yard was completely fenced in. LPA observed that all screens and gutters were in good repair. There were 3 separate conversation areas with furniture for residents to enjoy, two of which were shaded.

According to the California Code of Regulations, Title 22, there were no deficiencies observed during today's visit. Orange Orchard Home passed its pre-licensing inspection and this LPA completed Comp III with the DFA.

A copy of this report was provided.

Exit interview.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

LIC809 (FAS) - (06/04)

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