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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701221
Report Date: 09/27/2023
Date Signed: 09/27/2023 03:26:01 PM

Document Has Been Signed on 09/27/2023 03:26 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:PAULSON COMMUNITY - SEQUOIA HOME, THEFACILITY NUMBER:
502701221
ADMINISTRATOR:HEKIMIAN, VARTANFACILITY TYPE:
735
ADDRESS:2812 PAULSON RD.TELEPHONE:
(559) 577-4239
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 4CENSUS: 3DATE:
09/27/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Jessica VillasenorTIME COMPLETED:
03:45 PM
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Licensing program Analyst (LPA) Jason Lund arrived unannounced to conduct post-licensing visit. LPA Lund met with the Administrator Jessica Villasenor and explained the reason visit. Census: 3

LPA Lund & Administrator Jessica Villasenor toured/inspected the facility inside and outside. The facility has 1 common area, Staff office, a staff bathroom and 4 resident rooms with a bathroom in each. There is a meeting area, dining area, computer area, Health and Wellness area and a laundry area. There are client bathrooms with grab bars, paper towels and soap. There are cameras on the outside of the building and the inside common areas.

The Facility has a kitchen area with a sink, refrigerator and dishwasher. The facility has an 7-day supply of nonperishable and 2-day supply of perishable food. The medications are locked in the Staff office. There is a delayed egress on the front door, side gate from the backyard and exterior gate in the common area of the facility.

There are designated cabinets for client’s belongings outside of each room. Locked file cabinets are located in the staff office for files. Fire extinguishers and smoke detectors are current and in compliance with fire safety. First aid kit was checked and is complete.

No deficiencies cited during this visit. Exit interview held with the Administrator Jessica Villasenor and a copy of report left.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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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