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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700971
Report Date: 12/13/2024
Date Signed: 12/13/2024 05:04:27 PM

Document Has Been Signed on 12/13/2024 05:04 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ORCHID CAREFACILITY NUMBER:
392700971
ADMINISTRATOR/
DIRECTOR:		CHAN, MING HIMFACILITY TYPE:
735
ADDRESS:421 E BANBURY DRTELEPHONE:
(415) 321-0868
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:StaffTIME VISIT/
INSPECTION COMPLETED:
03:25 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
LPA Johnson was made aware that On 12-12-2024 at 5:00pm, the staff contacted the hospital and learned that R1 had a stroke and was being transferred to the telemetry floor for further observation.

There was no plan for him to be discharged yet. The facility has the following appointments scheduled when R1 is discharged.

- Dietitian Tele-Appointment: Mara Bernardo on 12/19/2024 at 2:00 PM


- Dr. Mok (Stanford): 1/7/2025 at 2:30 PM in Redwood City
- Psychiatrist Appointment: Dr. Lowry on 1/8/2025 at 10:30 AM
- Neurology Appointment: Dr. Zeba Vanek on 1/13/2025 at 11:00 AM
- Dr. Punjya Appointment: 1/15/2025 at 12:30 PM
- Sleep Disorder Specialist: Dr. Singh on 1/22/2025 at 1:40 PM
- Dr. Patel Appointment: 1/28/2025 at 2:00 PM

Exit interview conducted
Lisa RiosTELEPHONE: (916) 969-9685
Albert JohnsonTELEPHONE: (916) 217-1390
DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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 1