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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804025
Report Date: 03/19/2024
Date Signed: 03/19/2024 12:14:33 PM


Document Has Been Signed on 03/19/2024 12:14 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ZEALCARE HOMEFACILITY NUMBER:
286804025
ADMINISTRATOR:MARTINEZ, MADONNA GRACEFACILITY TYPE:
740
ADDRESS:2504 REDWOOD RD.TELEPHONE:
(707) 258-9348
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:6CENSUS: 4DATE:
03/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Rachel Espaldron, StaffTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an Annual Required inspection and was greeted by staff. Administrator, Madonna Grace Martinez was unavailable for today’s visit. There is 4 residents at facility, 4 with a dementia diagnosis, & 1 on hospice.

LPA initiated a tour of the facility at approximately 10:30am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Hot water temperature measured between 162.8. degrees F to 145. degrees F in 3 out of 3 resident’s bathroom faucets falling out of Title 22 acceptable regulation of 105 to 120 degrees F. Staff adjusted water heater during visit and informed maintenance will be out today to adjust further. Facility has had previous water heater problems last year and water heater replacement. LPA will return at a later date to check water temperatures. Extra hygiene products and linens were available. Cabinet in kitchen containing cleaning supplies and cabinet containing knives was locked with a baby lock. LPA discussed the limitations of a baby lock in order to keep dangerous items inaccessible and discussed other options with Administrator. LPA observed a can of disinfectant in the bathroom cabinet that was not locked allowing access to residents in care. Staff immediately locked cleaner. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. During visit it was revealed in conversation with Home Health Nurse that resident (R1) has a stage 4 ulcer and facility will need to submit exception request by close of business tomorrow (3/20/2024). Failure to do so will result in a citation for retaining a resident wit a prohibited condition.

Fire extinguisher was last inspected 2/14/2024. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational. Most recent fire/disaster drill was conducted January, 2023.

LPA initiated a file review of four resident files and 3 personnel files but were unable to complete. LPA was also unable to review medication and will return at a later date to complete annual inspection.

No deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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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