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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004215
Report Date: 08/22/2022
Date Signed: 08/22/2022 02:23:51 PM


Document Has Been Signed on 08/22/2022 02:23 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ORANGE VILLAS HOME CAREFACILITY NUMBER:
347004215
ADMINISTRATOR:LAZA ESTHERFACILITY TYPE:
740
ADDRESS:6851 BEECH AVENUETELEPHONE:
(916) 987-5780
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 6DATE:
08/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Esther Laza BolthausenTIME COMPLETED:
02:40 PM
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On 8/22/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required 1 year annual inspection. LPA met with Administrator, Esther Laza Bolthausen, and explained the purpose of the inspection.

Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

LPA toured the interior of the facility together with Administrator to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathrooms, kitchen and laundry room. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator followed the infection control domain guidelines and facility was found to be in substantial compliance at this time.

LPA reviewed a record daily temperature screening of residents. LPA observed the fire extinguisher to be up to date with last inspection to be February 11, 2022. LPA observed (3) Administrator Certificates posted: Derek Bolthausen, Esther Bolthausen, and Alexandru Timis. Administrator informed LPA her certificate is updated but she never received a new copy. LPA informed Administrator she will provide Administrator Cert email. Administrator provided an updated copy of the current liability insurance to be expired 5/23/2023. LPA advised Administrator to have trash can with lid for all restrooms.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2022
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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