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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004913
Report Date: 10/27/2022
Date Signed: 10/27/2022 09:50:04 AM


Document Has Been Signed on 10/27/2022 09:50 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:ZOSING CARE HOME IIFACILITY NUMBER:
397004913
ADMINISTRATOR:VELASQUEZ, ANGELICA & GENEFACILITY TYPE:
740
ADDRESS:2815 MIRASOL LANETELEPHONE:
(209) 955-1033
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:6CENSUS: 5DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Gene Velasquez - AdministratorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with administrator and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents.

LPA and administrator toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the resident bathroom was measured at 1 degrees Fahrenheit. There is a minimum of 7 day supply of nonperishable and 2 day of perishable foods. Fire Drill conducted 9/5/2022. The facility has central heating and air.

Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguishers were last inspected on . First aid kit was observed to be complete. LPA observed completed mitigation plan.
LPA reviewed two (2) residents files and four (4) staff files. Staff have current First Aid/CPR certificates.

No deficiencies were cited from the California Code of Regulations, Title 22.

Exit interview conducted with administrator and report left at facility..
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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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