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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005097
Report Date: 01/23/2025
Date Signed: 01/24/2025 08:38:01 AM

Document Has Been Signed on 01/24/2025 08:38 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MALONZO ELDERCARE, INC.FACILITY NUMBER:
507005097
ADMINISTRATOR/
DIRECTOR:
MALONZO, CLEOFE S.FACILITY TYPE:
740
ADDRESS:1709 ST. CHARLOTTE LANETELEPHONE:
(949) 378-1285
CITY:MODESTOSTATE: CAZIP CODE:
95358
CAPACITY: 5TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Administrator Gemma MalonzoTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst Jason Lund arrived unannounced to conduct a required one year inspection. LPA Lund met with Administrator Gemma Malonzo and explained the reason for the visit. Census:

LPA Lund & Administrator Gemma Malonzo toured/inspected the facility. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage and kitchen. Bedrooms were clean and in good repair. There is a locked storage for medications. Resident's medical files and medication were reviewed. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms and carbon monoxide detectors are installed, tested and are operational. LPA observed linens and found the first aid kit to be complete. Hot water temperature measures at 115.5 degrees F. Fire extinguishers were serviced in March 2024 and are in compliance. LPA reviewed 2 resident and 2 staff records. Resident files were found to be complete and current. A review of staff records indicates that all facility staff have received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates. Facility is conducted staff training as required.

No deficiencies were cited during this inspection. Exit interview conducted and report left.

Lisa RiosTELEPHONE: (916) 969-9685
Jason LundTELEPHONE: (916) 223-6752
DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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