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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700619
Report Date: 10/05/2023
Date Signed: 10/05/2023 02:47:58 PM

Document Has Been Signed on 10/05/2023 02:47 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:YELLOW ORCHID LLCFACILITY NUMBER:
342700619
ADMINISTRATOR:BHADE, KIRENDEEPFACILITY TYPE:
740
ADDRESS:9470 SEA CLIFF WAYTELEPHONE:
(916) 432-0685
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 6CENSUS: 4DATE:
10/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Sumeet BhadeTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski met with facility administrator Sumeet Bhade and explained the purpose of the visit.

LPA Moleski interviewed Bhade and a staff member (S1), and reviewed R1's file.

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Bhade.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
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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