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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004215
Report Date: 07/26/2023
Date Signed: 07/26/2023 11:47:53 AM


Document Has Been Signed on 07/26/2023 11:47 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: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:
07/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Administrator , Esther Laza TIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Talwinder Bains arrived on 07/26/23 to conduct the annual inspection. LPA met with administrator, Esther Laza and explained the purpose of the visit. LPA was told by administrator that facility has 6 residents in care as of today. Administrator holds a current administrator certificate number # 6000864740 with expiration date of 01/16/24.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (2) and staff files (2). All resident files contained the required paperwork. All staff files have all required paperwork including current first aid and CPR training. Facility was clean and well organized. All required posting were observed. Staff training contained the required initial training.

LPA and administrator toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. 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 that facility using centrally stored medications log and it appeared that medications were given per doctor's order to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. In the areas toured, there were no health or safety violations observed.

LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by 08/05/23.

No deficiency were observed or cited during today's visit. Exit interview conducted .
A copy of this report was printed and given to administrator.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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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