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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201147
Report Date: 07/08/2025
Date Signed: 07/08/2025 12:36:20 PM

Document Has Been Signed on 07/08/2025 12:36 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:
07/08/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator, Levente NagyTIME VISIT/
INSPECTION COMPLETED:
01:15 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 7/8/2025 at 8:00 AM, Licensing Program Analyst (LPA) A Gomez conducted a case management as a result of observations made during a visit on 6/19/2025. LPA met with Administrator, Levente Nagy and explained the purpose of the visit. Facility is licensed for 6 non-ambulatory.

During todays visit LPA observed that the facility is not maintaining resident files. Administrator states that the facility maintains a MAR but that it is kept off site. LPA also observed that facility is storing R1's medication in a weekly med organizer and not keeping the medication for the week in their original container. When LPA requested to review the staff files administrator stated that they do not have the files available. While reviewing residents files for the last 3 months LPA observed that the facility was over capacity in June 2025. R3 moved into the facility when the facility was already at full capacity. R2 passed away 3 days after R3 moved in. LPA also found that the facility never sent in a death report for R2. When LPA asked administrator why there was not a death report sent in they stated that they did not know they needed to submit a report because R2 was on hospice. LPA found during the visit on 6/19/2025 that staff may be leaving residents at the facility unsupervised. On today's visit LPA spoke with administrator who confirmed that they have approved staff to leave the residents alone in the facility and advised the staff to take the call button alert system so that they would know if a resident required assistance. LPA found that staff are living in an are designated for office space and that a cosmetology related business is being ran out of the storage area

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: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2025
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 7
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)
Page: 2 of 7
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: 07/08/2025
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
26
27
28
29
30
31
32
THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT:
  • Medications are not being properly stored
  • Staff are living in an designated office space and storage area is being utilized for an unrelated business where unknown individuals receive services.
  • Facility is not following reporting requirements and did not report a death
  • Residents records were not available upon demand
  • Facility is not maintaining records for all staff**
  • Facility is accepting residents beyond their approved capacity**
  • Administrator is not qualified and is neglecting their responsibilities


**Civil penalties in the amount of $1250 are being assessed for repeat violations**


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: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC809 (FAS) - (06/04)
Page: 7 of 7
Document Has Been Signed on 07/08/2025 12:36 PM - It Cannot Be Edited


Created By: Alona Gomez On 07/08/2025 at 11:31 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: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2025
Section Cited
CCR
87465(h)(5)

1
2
3
4
5
6
7
(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
By POC facility agrees to review the regulation and retrain all the staff on medication procedures and notify CCLD
8
9
10
11
12
13
14
Based on observations the facility did not comply with the section cited above by batching R1's medication for the week in a pill organizer which poses a potential health risk to resident in care.
8
9
10
11
12
13
14
Type B
07/17/2025
Section Cited
CCR87307(a)

1
2
3
4
5
6
7
(a)Living accommodations and grounds shall be related to the facility's function....The following provisions shall apply:

This requirement was not met as evidence by:
1
2
3
4
5
6
7
By POC facility agrees to start the process of obtaining a new fire clearence for the office space and submit a plan for the unapproved business and notify CCLD
8
9
10
11
12
13
14
Based on observations and interview the facility did not comply with the section cited above by by staff living in an office space and running an unapproved business not related to the facilities function which poses a potential personal rights violation to resident in care.
8
9
10
11
12
13
14
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: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2025


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 07/08/2025 12:36 PM - It Cannot Be Edited


Created By: Alona Gomez On 07/08/2025 at 11:39 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: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2025
Section Cited
CCR
87211(a)(1)(A)

1
2
3
4
5
6
7
(a)Each licensee shall furnish...(1)A written report ... within seven days... (A)Death of any resident...from the facility.

This requirement was not met as evidence by:
1
2
3
4
5
6
7
By POC facility agrees to review the regulation and submit any and all death reports not previously submitted and notify CCLD
8
9
10
11
12
13
14
Based on record review and interview the facility did not comply with the section cited above by not reporting the death of R2 which poses a potential personal rights violation to residents in care.
8
9
10
11
12
13
14
Type B
07/17/2025
Section Cited
CCR87506(d)

1
2
3
4
5
6
7
(d)All resident records shall be available...upon demand... following requirements:


This requirement was not met as evidence by:
1
2
3
4
5
6
7
By POC facility agrees to update records and files and notify CCLD
8
9
10
11
12
13
14
Based on record review and interview the facility did not comply with the section cited above by not having residents records upon demand which poses a potential personal rights violation to residents in care.
8
9
10
11
12
13
14
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: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2025


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 07/08/2025 12:36 PM - It Cannot Be Edited


Created By: Alona Gomez On 07/08/2025 at 11:58 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: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/08/2025
Section Cited
CCR
87202(a)

1
2
3
4
5
6
7
(a)All facilities shall maintain a fire clearance approved by the ...State Fire Marshal.

This requirement is not met as evidence by:
1
2
3
4
5
6
7
Facility is no longer over capacity POC clear.
8
9
10
11
12
13
14
Based on record review and interview the facility did not comply with the section cited above by being over their fire clearence capacity which posed an immediate safety risk to resident in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2025


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 07/08/2025 12:36 PM - It Cannot Be Edited


Created By: Alona Gomez On 07/08/2025 at 12:02 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: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2025
Section Cited
CCR
87405(a)

1
2
3
4
5
6
7
(a)All facilities shall have a qualified and currently certified administrator...to fulfill his/her responsibilities...

This requirement is not met as evidence by:
1
2
3
4
5
6
7
By POC administrator agrees to sign up for refresher courses taught by an approved CCLD vendor and notify CCLD
8
9
10
11
12
13
14
Based on observations and interview the facility did not comply with the section cited above by Administrator lacking the knowledge to adequetly fo their duties which poses a potential personal rights risk to residents in care.
8
9
10
11
12
13
14
Type B
07/17/2025
Section Cited
CCR87412(a)

1
2
3
4
5
6
7
(a)The licensee shall ensure that personnel records are maintained ...

This requirement is not met as evidence by:
1
2
3
4
5
6
7
By POC administrator agrees to update all files and notify CCLD
8
9
10
11
12
13
14
Based on record review and interview the facility did not comply with the section cited above by not having all staff files which poses a potential personal rights violation to residents in care.
8
9
10
11
12
13
14
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: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2025


LIC809 (FAS) - (06/04)
Page: 6 of 7