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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004232
Report Date: 02/09/2023
Date Signed: 02/09/2023 11:07:12 AM


Document Has Been Signed on 02/09/2023 11:07 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ORANGEVALE HOME CAREFACILITY NUMBER:
347004232
ADMINISTRATOR:SMILCA CAZAFACILITY TYPE:
740
ADDRESS:6829 BEECH AVENUETELEPHONE:
(916) 987-8878
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 1DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Caza Smilca, LicenseeTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Bains arrived at the facility unannounced on 02/09/2023 to conduct a Required 1 Year Inspection utilizing the infection control domain, LPA met with Licensee, Caza Smilca and explained the purpose of the visit.

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 and contacted facility and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

Licensee stated that there was only one resident in care for now.

LPA and Licensee toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, kitchen, resident bedrooms, staff room, bathrooms and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA and Licensee completed the infection control domain together and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.
Exit interview conducted and copy of report left at the facility.



SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023
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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