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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004232
Report Date: 03/14/2024
Date Signed: 03/14/2024 11:29:55 AM


Document Has Been Signed on 03/14/2024 11:29 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:ORANGEVALE HOME CAREFACILITY NUMBER:
347004232
ADMINISTRATOR:SMILCA CAZAFACILITY TYPE:
740
ADDRESS:6829 BEECH AVENUETELEPHONE:
(916) 987-8878
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 0DATE:
03/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Administrator, Caza SmilcaTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct an annual inspection. LPA met with Administrator Caza Smilca and administrator informed LPA that the facility is empty for now.

LPA toured the facility with administrator. LPA observed no resident is living at the facility. Administrator informed LPA that they are doing updates to the property. At this time the administrator is not admitting residents to the home.

No deficiencies cited during today's inspection per Title 22 ,CCR Regulations. .

Exit interview conducted and copy of this report has been provided.






SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024
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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