<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920257
Report Date: 03/12/2025
Date Signed: 03/12/2025 10:04:39 AM

Document Has Been Signed on 03/12/2025 10:04 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SIERRA HEALTH AND WELLNESS-ORANGEVALEFACILITY NUMBER:
345920257
ADMINISTRATOR/
DIRECTOR:
PHAM, LORNAFACILITY TYPE:
772
ADDRESS:5820 CHESTNUT AVETELEPHONE:
(530) 712-7482
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 15CENSUS: 0DATE:
03/12/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator, Lorna Pham TIME VISIT/
INSPECTION COMPLETED:
10:15 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 03/12/2025, Licensing Program Analyst (LPA) Talwinder Bains met with Administrator Lorna Pham to conduct an announced Pre-Licensing visit. Vanessa Potier Watts , Regional Director of Operations and Ryan Hofman Maintenance Specialist Lead were also present during today's visit. Facility has an approved fire clearance for 15 ambulatory residents.

LPA and Administrator conducted a tour of the facility. Areas toured include but not limited to residents bedrooms, bathrooms, staff office, storage area, activity area , kitchen and outside area. Bathrooms and bedrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors to be operational. Fire extinguisher and first aid kit are maintained and ready for emergency use. Water temperature was measured in the kitchen sink at 120 degrees, which is within the required range.

Pre-licensing passed and Component III was waived as administrator has other licensed facilities with Community Care Licensing (CCL).



Facility has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. Administrator to notify LPA when first resident moves in.

No citations were observed or cited per Title 22 Regulations from this visit.

Exit interview conducted a copy of the report was left at the facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1