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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005711
Report Date: 11/07/2023
Date Signed: 11/07/2023 01:45:51 PM

Document Has Been Signed on 11/07/2023 01:45 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
SACRAMENTO AC/SC, 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: 26DATE:
11/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kathy RhymesTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Kathy Rhymes and explained the purpose of the visit.

LPA Moleski reviewed 10 client files (C1-C10) and 10 staff files (S1-S10).

LPA Moleski toured the facility with Rhymes and inspected common areas, a kitchen, bathrooms. Furniture and furnishings were sufficient to meet the needs of clients. The facility temperature was 70 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 105 degrees Fahrenheit, which is within the required range of 105 and 120 degrees.

LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and smoke detectors. LPA Moleski observed locked closets for the storage of cleaning solutions.

LPA Moleski interviewed five staff members (S4, S6, S10, S11, S12) and four clients (C11-C14).

No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Rhymes.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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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