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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700971
Report Date: 09/18/2023
Date Signed: 09/18/2023 04:08:18 PM

Document Has Been Signed on 09/18/2023 04:08 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ORCHID CAREFACILITY NUMBER:
392700971
ADMINISTRATOR:CHAN, MING HIMFACILITY TYPE:
735
ADDRESS:421 E BANBURY DRTELEPHONE:
(415) 321-0868
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 4CENSUS: 2DATE:
09/18/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ming Him (Ryan) ChanTIME COMPLETED:
03:00 PM
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 9/18/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a post licensing visit. LPA Jensen met with Ryan Chan and explained the purpose of today's visit.

LPA Jensen toured the grounds and observed them to be maintained and all paths were cleared of obstruction. LPA Jensen observed outdoor furniture and shaded areas available for client outdoor activities.

LPA Jensen toured the interior of the facility including living room, dining room, kitchen, bedrooms, and bathrooms. The facility was observed to be sanitary and free of odor. LPA Jensen observed adequate furniture and lighting throughout. The facility thermostat was set at 78 degrees and is within the required range. The water temperature was measured at 105.8 degrees in the bathroom and is in compliance.

The facility maintains a first aid kit that is complete. The fire extinguisher was last serviced in May of 2023 and is in compliance. The smoke detector and carbon monoxide detector was tested and found to be in good working order.

Knives and toxins were observed to be locked and inaccessible to clients in care. Medications were locked and inaccessible to clients in care. LPA Jensen conducted a random audit of medications and found the record keeping to be accurate. LPA Jensen conducted a random audit of the P&I funds and found them to accounting to be accurate.

LPA Jensen observed in excess of 7 days of non-perishable food and 2 days of perishable food. There was fresh fruit available for snacks.

Continued on LIC 809C....
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: ORCHID CARE
FACILITY NUMBER: 392700971
VISIT DATE: 09/18/2023
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
26
27
28
29
30
31
32
LPA Jensen reviewed 2 of 2 staff files and 2 of 2 resident files and found them to be complete.

The facility was found to be in substantial compliance and no deficiencies are being cited. Technical assistance was provided regarding modified diets.

An exit interview was conducted and a copy of this report and appeal rights were provided .
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3