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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201147
Report Date: 06/19/2025
Date Signed: 06/19/2025 01:12:19 PM

Document Has Been Signed on 06/19/2025 01:12 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: 6DATE:
06/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Caregiver, Voichita Stoica TIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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On 6/19/2025 at 8:00 AM, Licensing Program Analyst (LPA) A Gomez conducted a case management as a result of finding out that the facility does not have a facility phone for resident use. LPA met with Caregiver, Voichita Stoica (Gabriella) and explained the purpose of the visit. Licensee and Administrator were unavailable. Facility is licensed for 6 non-ambulatory

On 6/17/2025 LPA contacted Licensee to inquire about facility documentation when they noticed that there was not a facility phone number available. LPA asked Licensee for facility phone number as to update the system information. Licensee stated that the facility does not have a designated phone. LPA inquired as to how residents have access to a phone. Licensee stated that residents must ask a staff to use their personal cell phone or have their own. Upon arrival to the facility for the case management LPA observed that staff where not answering the door. The front door was unlocked and when LPA entered they called out and there was no answer. LPA observed 4 residents unsupervised sitting in the dinning and kitchen area. LPA also observed a black kitchen knife in the kitchen on the counter. LPA walked throughout the facility and located S1 assisting a resident getting dressed and S2 mopping the bathroom floor. Through interview LPA also found that residents have been left unsupervised with no staff at the facility. Facility staff was unable to locate staff/resident files and lacked the tools to effectively assist residents in care. LPA also interviewed S1 and S2.

Report Continues on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Yvonne Flores-Larios
NAME OF LICENSING PROGRAM ANALYST: Alona Gomez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ALAMO CARE HOME
FACILITY NUMBER: 079201147
VISIT DATE: 06/19/2025
NARRATIVE
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THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT:
  • Staff are not adequately trained *
  • There is not a designated facility phone
  • Residents are left unsupervised*
  • Dangerous items are left out (Kitchen Knife) *
  • Facility Does not have adequate/competent staffing*
  • Facility Files not available upon request*
  • Facility does not have an adequate substitute for Administrator when Administrator is away*

***Administrator was away during visit and was not answering the phone. LPA had staff sign off on todays report

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.
NAME OF LICENSING PROGRAM MANAGER: Yvonne Flores-Larios
NAME OF LICENSING PROGRAM ANALYST: Alona Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 06/19/2025 01:12 PM - It Cannot Be Edited


Created By: Alona Gomez On 06/19/2025 at 10:51 AM
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: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/19/2025
Section Cited
CCR
87309(a)

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(a) Except as specified.. the licensee shall ensure... knives...are in locked storage and are not left unattended...

This requirement is not met as evidence by:
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Caregiver locked away dangerous items.
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Based on observation the Licensee did not comply with the above regulation by having an accessible knife which poses an immediate safety risk to persons in care.
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Type A
06/26/2025
Section Cited
CCR87464(f)(1)

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(f) Basic services shall at a minimum include:(1) Care and supervision...
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By POC Facility agrees to implement a sign in and sign out sheet for all staff and notify CCLD
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Based on observation and interview the Licensee did not comply with the above regulation by not providing adequate supervision 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.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/19/2025 01:12 PM - It Cannot Be Edited


Created By: Alona Gomez On 06/19/2025 at 11:08 AM
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: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2025
Section Cited
CCR
87411(a)

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(a) Facility personnel shall at all times be sufficient...for the provision of adequate services.

This requirement is not met as evidence by:
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By POC Facility agrees to hire additional staff and notify CCLD
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Based on observation the Licensee did not comply with the above regulation by not having adequete and competent staff which poses a potential safety risk to persons in care.
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Type B
06/26/2025
Section Cited
CCR87755(c)

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(c) The licensing agency shall have the authority to inspect... records upon demand...

This requirement is not met as evidence by:
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By POC facility agrees to create a designated spot for all files that can be accessed by staff and notify CCLD
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Based on interview the Licensee did not comply with the above regulation by not having records available upon demand which poses a potential personal rights 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.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/19/2025 01:12 PM - It Cannot Be Edited


Created By: Alona Gomez On 06/19/2025 at 11:28 AM
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: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2025
Section Cited
CCR
87405(a)

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(a) All facilities shall have a ... designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility ...


This requirement is not met as evidence by:
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By POC Facility agrees to hire a backup administrator and notify CCLD
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Based on interview the Licensee did not comply with the above regulation by not having a substitute administrator in their absence which poses a potential personal rights risk to persons in care.
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Type B
06/26/2025
Section Cited
CCR87411(4)

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(4) All training shall be conducted by a person...who satisfies at least one of the following criteria related to education and experience:

This requirement is not met as evidence by:
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By POC Facility agrees to retrain all staff utilizing a CCL approved vendor and submit the name of vendors and scheduled trainings to CCLD
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Based on interview the Licensee did not comply with the above regulation by S3 and S4 not have been trained according to regulation which poses a potential personal rights 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.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2025


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 06/19/2025 01:12 PM - It Cannot Be Edited


Created By: Alona Gomez On 06/19/2025 at 01:03 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: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2025
Section Cited
CCR
87311

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 All facilities shall have telephone service on the premises...

This requirement is not met as evidence by:
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By POC facility agrees to obtain phone service that stays on the premises for resident use and notify CCLD
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Based on interview the Licensee did not comply with the above regulation by not having a designated facility phone which poses a potential personal rights 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.
Yvonne Flores-Larios
NAME OF LICENSING PROGRAM MANAGER:
Alona Gomez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2025


LIC809 (FAS) - (06/04)
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