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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700971
Report Date: 11/26/2024
Date Signed: 11/27/2024 09:15:36 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/05/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241105103627
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: 4DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Bayog.JTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff do not provide a comfortable environment for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Albert Johnson made an unannounced visit to deliver findings for the above allegation. LPA spoke with Administrator and explained the purpose of the visit.

Based on interviews with the residents and the staff the facility is meeting the needs of the residents in care . The facility is a level 4I home and the residents are allowed to make choices and to receive related personal services in the community (rather than on site) based on their needs, preferences and abilities.

Continued
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20241105103627
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ORCHID CARE
FACILITY NUMBER: 392700971
VISIT DATE: 11/26/2024
NARRATIVE
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The residents can lock their door when they leave and have the expectation that no one will enter without their permission. The residents have the freedom and support to control their own schedules and activities and have access to food at any time. The residents have the freedom to furnish and decorate their sleeping or living units the way they choose to within the lease or other agreements.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2