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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701221
Report Date: 01/30/2025
Date Signed: 01/30/2025 11:50:09 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/30/2025 11:50 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PAULSON COMMUNITY - SEQUOIA HOME, THEFACILITY NUMBER:
502701221
ADMINISTRATOR/
DIRECTOR:		HEKIMIAN, VARTANFACILITY TYPE:
735
ADDRESS:2812 PAULSON RD.TELEPHONE:
(559) 577-4239
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY: 4CENSUS: 4DATE:
01/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Team Lead, Jessica VillasenorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Administrative Team Lead, Jessica Villasenor and explained the purpose of the visit. The facility is a one story building meant to house four ambulatory residents between the ages of 18 to 59. One room is suitable for a non-ambulatory resident if needed. There are exits with delayed egress in the building and a secured perimeter surrounds the facility. The facility receives referrals from Central Valley Regional Center.

LPA Campbell toured the facility and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas to ensure there are no safety hazards for residents. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 70 degrees Fahrenheit (F), which is within the required range of 68 and 85 degrees F. The facility's water temperature measured 118 degrees F in the bathroom and 120 degrees F in the kitchen, which is within the required range of 105 and 120 degrees F. Pathways and exits in the backyard were found to be clear. The fire extinguisher was last inspected on 06/12/2024.

LPA Campbell observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Campbell observed a locked office for the storage of medication and a locked storage area for the storage of cleaning solutions. There was a locked drawer in the kitchen for knives as well. Four randomly selected staff files were reviewed and found to be complete.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PAULSON COMMUNITY - SEQUOIA HOME, THE
FACILITY NUMBER: 502701221
VISIT DATE: 01/30/2025
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Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited. An exit interview was conducted with Jessica Villasenor and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC809 (FAS) - (06/04)
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