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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005711
Report Date: 10/20/2022
Date Signed: 10/20/2022 11:25:22 AM

Document Has Been Signed on 10/20/2022 11:25 AM - 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: 5DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kathy Rhymes - AdministratorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit. LPA explained purpose of today's visit with administrator. LPA observed required COVID measures were observed. LPA was allowed entry into the facility that is licensed to serve a total capacity of 30 clients and temperature was taken,

LPA and senior assistant clerical The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility conducts fire drills monthly. LPA observed the thermostat temperature inside the facility hallway was measured at 74 *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 108.5 *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. LPA observed a pull alarm system, fire extinguisher(s) were inspected 4/26/22, smoke and carbon monoxide detectors, central heating and air in the facility. Mitigation Plan was submitted and approved.

LPA reviewed four (4) Staff and four (4) Client files that were locked and readily available for review. Staff had current First Aid/CPR certificates. One staff (S1) was not fingerprint cleared and never associated to facility.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, there was one deficiency cited during this visit. Exit interview held with administrator. Copies of reports and appeal rights were given to administrator.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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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Document Has Been Signed on 10/20/2022 11:25 AM - It Cannot Be Edited


Created By: Ruth Wallace On 10/20/2022 at 10:23 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
, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ZENCAR SERVICES INC
FACILITY NUMBER: 347005711

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82019(e)(1)
Criminal Record Clearance
(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: (1) Obtain a California clearance or a criminal record exemption as required by the Department; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA record review, the licensee did not comply with the section cited above in Staff 1 does not have a criminal record clearance and is not associated to facility. Immediate $500.00 Civil Pealty Assessed on 10/20/22. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2022
Plan of Correction
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Licensee agrees to submit plan of correction by 10/21/22 stating that all employees must have criminal record clearances and be associated to facility before working.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME:Stephen Richardson
LICENSING EVALUATOR NAME:Ruth Wallace
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022


LIC809 (FAS) - (06/04)
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