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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004232
Report Date: 03/12/2025
Date Signed: 03/12/2025 12:47:26 PM

Document Has Been Signed on 03/12/2025 12:47 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ORANGEVALE HOME CAREFACILITY NUMBER:
347004232
ADMINISTRATOR/
DIRECTOR:		SMILCA CAZAFACILITY TYPE:
740
ADDRESS:6829 BEECH AVENUETELEPHONE:
(916) 987-8878
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 6CENSUS: 1DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Administrator, Caza SmilcaTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 03/12/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct an annual inspection. LPA met with Administrator Caza Smilca and explained the purpose of today's visit.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed one (1) resident file and found all required documents.

LPA and administrator toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher was ready for emergency use. Facility was clean and well organized. All required postings were observed.

No deficiencies were observed or cited per Title 22, CCR Regulations during this visit.
Exit interview conducted and copy of this report was provided to administrator.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
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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