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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701221
Report Date: 03/12/2025
Date Signed: 03/12/2025 10:15:17 AM

Document Has Been Signed on 03/12/2025 10:15 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:
03/12/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Jessica Willasenor, Administrative Team LeadTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a Case Management regarding completed client files. LPA Campbell met with Administrative Team Lead, Jessica Villasenor and explained the purpose of the visit.

During the course of the visit, LPA Campbell requested the files for Paulson Sequoia Home. Upon review, R1's LIC 602 was reviewed and was signed by a physician as of 02/10/2025. The TB test was completed with no signs of TB. R1 is an ambulatory resident who is capable of overseeing most activities of daily living.

R2's LIC 602 was also found and reviewed with similar information as R1.
The deficiency can now be cleared.
Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 8, no deficiencies are being cited.

An exit interview was conducted with administrator and a copy of this report was provided. 
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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