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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397002074
Report Date: 03/18/2025
Date Signed: 03/18/2025 04:42:28 PM

Document Has Been Signed on 03/18/2025 04:42 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AZEL RESIDENTIAL FACILITIES, INC.FACILITY NUMBER:
397002074
ADMINISTRATOR/
DIRECTOR:		CECIL F. KEBEFACILITY TYPE:
735
ADDRESS:4667 BRECKINRIDGE COURTTELEPHONE:
(209) 834-8988
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 6CENSUS: 2DATE:
03/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Cecil F. Kebe TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 03/18/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual visit. LPA Pascua was greeted by Facility Designated Administrator, Cecil Kebe and explained the purpose of the visit. This facility is licensed to serve 6 residents who are deemed to be
ambulatory only. This facility is also vendorized by Valley Mountain Regional center to serve and accept Level 4I residents. The administrator has an active certificate #6012904735 and expired on 03/14/2024. The administrator had sent in the correct paperwork prior to 03/14/2024.

Current Census was 2. LPA Pascua reviewed 2 resident files. 2 out of 2 resident files were current and up to date. LPA Pascua reviewed 2 staff file which was current and up to date.

LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components.

A tour with FDA Kebe was conducted. Fire extinguisher located in the hallway was serviced by Fire Service Company on 03/16/2025 and is in compliance in this time.

Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time.
Kitchen area was toured. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care.

A tour of the garage was conducted. Additional food supply was identified.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: AZEL RESIDENTIAL FACILITIES, INC.
FACILITY NUMBER: 397002074
VISIT DATE: 03/18/2025
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A tour of the laundry room was conducted, laundry detergent, bleach and all other cleaning supplies were made inaccessible to the residents at this time.
A tour of the 3 resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time.
A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees.
The exterior of the physical plant was in good repair with no hazards present. Perimeter fence was observed to be stable and gates were in good repair.

The following forms and documents were requested to be updated and submitted into CCL.
-LIC 308
-LIC 400
-LIC 500
-LIC 610e

No deficiencies were observed or cited during this annual visit. A copy of this report was given to Facility Designated Administrator.
Exit interview was conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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