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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881699
Report Date: 02/12/2025
Date Signed: 02/12/2025 03:31:07 PM

Document Has Been Signed on 02/12/2025 03:31 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ZECHARIAH HOMEFACILITY NUMBER:
331881699
ADMINISTRATOR/
DIRECTOR:		MADERA, LARISAFACILITY TYPE:
737
ADDRESS:29220 VIA LAS PALMASTELEPHONE:
(760) 600-7578
CITY:THOUSAND PALMSSTATE: CAZIP CODE:
92276
CAPACITY: 4CENSUS: 3DATE:
02/12/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Larisa MaderaTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA),Abdoulaye Zerbo conducted an unannounced visit to the facility for a health an safety check. The LPA met with Administrator Larisa Madera, and informed her of the purpose of the visit and was granted access.

The facility is a single story building and consists four(4) resident bedrooms, three (3) bathrooms, a living room, a kitchen area, and a gated pool meeting the department's requirement.

LPA's case management included interview with management and staff, obtaining pertinent documentation and conducting a tour of the facility for a health and safety check. No health and safety concerns were observed during today's visit. According to the Administrator Larisa Madera and Director Ericka Munoz, an internal investigation is being conducted. LPA was informed that Staff 1 has been suspended, pending the investigation.
Administrator Larisa Madera was advised that possible visits and phone interviews will be conducted before a decision is rendered. An exit interview was conducted, and a copy of this report was provided to Administrator Larisa Madera.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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