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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005711
Report Date: 10/06/2021
Date Signed: 10/06/2021 02:12:44 PM

Document Has Been Signed on 10/06/2021 02:12 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ZENCAR SERVICES INCFACILITY NUMBER:
347005711
ADMINISTRATOR:RHYMES, KATHYFACILITY TYPE:
775
ADDRESS:3125 DWIGHT ROAD 500TELEPHONE:
(916) 737-5207
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 30CENSUS: 0DATE:
10/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Senior Coordinator Christine Abucay TIME COMPLETED:
02:15 PM
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On 10-6-21 Licensing Program Analyst (LPA)s Tirzah Hubbard and Christina Valerio arrived unannounced to conduct a Required – 1 Year inspection. LPAs contacted the facility to ask follow up questions in regard to Covid-19. LPAs spoke with the Licensee and Manager Pamela Miranda to ask follow up questions for Covid-19 symptoms. LPAs proceeded to approach the facility to conduct the Annual after the facility was cleared. All required COVID measures were observed. LPAs observed S1 and Administrator wearing mask upon entry. S1 took the temperature of LPAs and asked Covid-19 screening questions. LPAs were allowed entry into the facility that is licensed to serve a total capacity of 30 clients. The physical plant was toured inside and outside to ensure the safety of the residents.

LPAs observed the facility conducts fire drills monthly. LPAs observed the thermostat temperature inside the facility hallway was measured at 76 *F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. The hot water was measured at 108 *F which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations.

The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPAs observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Tirzah Hubbard
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: ZENCAR SERVICES INC
FACILITY NUMBER: 347005711
VISIT DATE: 10/06/2021
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Mitigation Plan was submitted and approved.

Upon a file review the following items were discussed to be submitted with any changes annually:

Criminal Record Clearances LIC508
Administrative Organization LIC309
Designation of Administrative Responsibility LIC308
Personnel Report LIC500
Qualifications of Administrator/Facility Manager- Administrator certificate
Emergency Disaster Plan LIC610D

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, there were no deficiencies cited during this visit. Exit interview held and a copy of report was provided in email for signature from licensee and copies faxed and emailed back.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Tirzah Hubbard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC809 (FAS) - (06/04)
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