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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209501
Report Date: 12/04/2024
Date Signed: 12/04/2024 08:15:06 PM

Document Has Been Signed on 12/04/2024 08:15 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ZEN HOUSE OF CAREFACILITY NUMBER:
107209501
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, NORA P.FACILITY TYPE:
740
ADDRESS:7251 E. HARVARD AVETELEPHONE:
(559) 577-2632
CITY:FRESNOSTATE: CAZIP CODE:
93737
CAPACITY: 6CENSUS: 2DATE:
12/04/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:14 PM
MET WITH:Licensee, Nora SanchezTIME VISIT/
INSPECTION COMPLETED:
08:20 PM
NARRATIVE
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On 12/4/24 Licensing Program Analyst (LPA) M. Garza conducted an unannounced Post-Licensing inspection. LPA met with Licensee, Nora Sanchez.

LPA completed tour of the facility inside and out including the kitchen, bedrooms, bathrooms and laundry area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed the required 7-day non-perishable and 2-day perishable foods. Medications and knives locked and inaccessible to residents. Water temperature measured at 115.8 degrees F in the restroom #1. Fire extinguisher present and purchased 1/4/24. Review of resident/staff files and medication records.

LPA observed the following posted in the facility: Resident Council Rights, See Something Say Something complaint poster, Reporting Requirements per AB40, Resident Bill of rights, Ombudsman Poster, Resident Personal Rights and facility license posted as required.

The following issues were observed during today’s visit: The following issues were observed during today’s visit: Facility missing lighting and hand railing at front walkway stairs. Staff observed assisting residents without fingerprint clearance. R1 observed walking in hallway with missing pants. R1 observed sleeping on mattress on the floor without exception.

Deficiencies and TV’s provided per Title 22. Exit interview completed with Licensee, Nora. A copy of the report, deficiencies, TV’s and appeal rights provided.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 12/04/2024 08:15 PM - It Cannot Be Edited


Created By: Mary Garza On 12/04/2024 at 07:19 PM
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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ZEN HOUSE OF CARE
FACILITY NUMBER: 107209501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1569.17(b)(1)(C)
Licensing
(C) Any person who provides client assistance in dressing, grooming, bathing, or personal hygiene. Any nurse assistant or home health aide meeting the requirements of Section 1338.5 or 1736.6, respectively, who is not employed, retained, or contracted by the licensee, and who has been certified or recertified on or after July 1, 1998, shall be deemed to meet the criminal record clearance requirements of this section. A certified nurse assistant and certified home health aide who will be providing client assistance and who falls under this exemption shall provide one copy of their current certification, prior to providing care, to the residential care facility for the elderly. The facility shall maintain the copy of the certification on file as long as the care is being provided by the certified nurse assistant or certified home health aide at the facility. Nothing in this paragraph restricts the right of the department to exclude a certified nurse assistant or certified home health aide from a licensed residential care facility for the elderly pursuant to Section 1569.58.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA interviews and records reviewed it was confirmed that S1 was not fingerprint cleared or associated to the facility and was working there at the time of the visit. This poses an immediate health, safety and or personal rights risk to residents in care
POC Due Date: 12/05/2024
Plan of Correction
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Staff was immediately removed from the facility and will not return to work until fingerprint cleared.

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:See Moua
LICENSING EVALUATOR NAME:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


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Document Has Been Signed on 12/04/2024 08:15 PM - It Cannot Be Edited


Created By: Mary Garza On 12/04/2024 at 07:19 PM
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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ZEN HOUSE OF CARE
FACILITY NUMBER: 107209501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87307(d)(4)
Personal Accommodations and Services
(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above as facility did not have hand railing or lighting at front entrance stairway. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2024
Plan of Correction
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Licensee stated they will purchase a hand rail and lighting to place at front entrance. Pictures will be provided to CCL as proof of correction by POC date.
Type B
Section Cited
CCR
87468.1(a)(1)
Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above. R1 was observed transferring from one room to another and walking in hallway without any pants or covered up. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2024
Plan of Correction
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Administrator stated they will complete an in-service training with staff on personal rights. In-service sign in sheet and training material will be provided to CCL as proof of correction by POC date.
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:See Moua
LICENSING EVALUATOR NAME:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


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Document Has Been Signed on 12/04/2024 08:15 PM - It Cannot Be Edited


Created By: Mary Garza On 12/04/2024 at 08:03 PM
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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ZEN HOUSE OF CARE
FACILITY NUMBER: 107209501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87468.1(a)(2)
87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above. R1 was observed sleeping on a hospital mattress on the floor. Facility does not have a physicians order, letter of support or exception in resident file. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2024
Plan of Correction
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Administrator stated they will get required documentation and submit to CCL for approval of an exception.
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:See Moua
LICENSING EVALUATOR NAME:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2024


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