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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700619
Report Date:
04/25/2024
Date Signed:
04/25/2024 10:54:59 AM
Document Has Been Signed on
04/25/2024 10:54 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:
YELLOW ORCHID LLC
FACILITY NUMBER:
342700619
ADMINISTRATOR/
DIRECTOR:
BHADE, KIRENDEEP
FACILITY TYPE:
740
ADDRESS:
9470 SEA CLIFF WAY
TELEPHONE:
(916) 432-0685
CITY:
ELK GROVE
STATE:
CA
ZIP CODE:
95758
CAPACITY:
6
CENSUS:
3
DATE:
04/25/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:
Sumeet Bhade
TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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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 provided Bhade an updated license reflecting an updated facility capacity. LPA Moleski collected this facility's previous license. LPA Moleski reviewed additional requirements for care of bedridden residents with Bhade.
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:
04/25/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/25/2024
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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