<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920080
Report Date: 05/20/2024
Date Signed: 05/20/2024 12:51:16 PM

Document Has Been Signed on 05/20/2024 12:51 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:VILLA ELISA-ORANGEVALEFACILITY NUMBER:
345920080
ADMINISTRATOR/
DIRECTOR:		POSADAS-WORSFORD, ELOISA MFACILITY TYPE:
740
ADDRESS:8501 OAKCREEK COVE WAYTELEPHONE:
(916) 548-4409
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 6CENSUS: 5DATE:
05/20/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Licensee, Mary Maybel Mata TIME VISIT/
INSPECTION COMPLETED:
01:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/20/24, Licensing Program Analyst Talwinder Bains arrived to conduct an unannounced Post Licensing inspection. LPA met with Licensee, Mary Maybel Mata (Mary) and explained the purpose of today's visit.

LPA reviewed 1 resident and 1 staff files. All residents files contained the required paperwork. Staff file contained the required paperwork and training. Facility is current on fire drills.

LPA toured the facility with Mary. The following areas were inspected: backyard, resident rooms, resident bathrooms, kitchen, and common area. In the areas toured, there were no health or safety violations observed.

No deficiencies cited per Title 22 Regulations. An exit interview conducted. A copy of this report was provided.







SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1