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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201147
Report Date: 01/30/2025
Date Signed: 01/30/2025 03:45:54 PM

Document Has Been Signed on 01/30/2025 03:45 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:ALAMO CARE HOMEFACILITY NUMBER:
079201147
ADMINISTRATOR/
DIRECTOR:		NAGY, ARPADFACILITY TYPE:
740
ADDRESS:2795 MIRANDA AVE.TELEPHONE:
(925) 413-3578
CITY:ALAMOSTATE: CAZIP CODE:
94507
CAPACITY: 6CENSUS: 7DATE:
01/30/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Caregiver, Voichita Stoica (Gabriella)TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 1/30/2025 at 3:00 PM, Licensing Program Analysts (LPAs) A Gomez conducted a case managment visit while at the facility for complaint 15-AS-20250124160912. LPA met with Caregiver, Voichita Stoica (Gabriella) and explained the purpose of the visit. Licensee and Administrator were unavailable. Licensee confirmed via phone that caregiver can sign the report. Facility is licensed for 6 non-ambulatory

While conducting the investigation for complaint 15-AS-20250124160912 LPA observed that the facility is over capacity. Facility is licensed for 6 residents and currently has 7. Facility is using an approved staff bedroom as a resident room. LPA is assesing an immediate $500 civil penalty for violation of 87202(a) Fire Clearance.

***A Civil Penalty of $500 is being assessed***

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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Document Has Been Signed on 01/30/2025 03:45 PM - It Cannot Be Edited


Created By: Alona Gomez On 01/30/2025 at 03:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: ALAMO CARE HOME
FACILITY NUMBER: 079201147

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2025
Section Cited
CCR
87202(a)

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(a)All facilities shall maintain a fire clearance ...State Fire Marshal.

This requirement is not met as evidence by:
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By POC Facility agrees to contact other facilities to begin the process of relocating resident and update CCLD of their progress.
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Based on observation and interview the facility did not comply with the above regulation by having 7 residents when they are cleared for 6 which poses an immediate safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Yvonne Flores-Larios
LICENSING EVALUATOR NAME:Alona Gomez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2025


LIC809 (FAS) - (06/04)
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