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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286804025
Report Date: 10/02/2024
Date Signed: 10/02/2024 03:26:08 PM

Document Has Been Signed on 10/02/2024 03:26 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ZEALCARE HOMEFACILITY NUMBER:
286804025
ADMINISTRATOR/
DIRECTOR:
MARTINEZ, MADONNA GRACEFACILITY TYPE:
740
ADDRESS:2504 REDWOOD RD.TELEPHONE:
(707) 258-9348
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY: 6CENSUS: 5DATE:
10/02/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Madonna MartinezTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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At approximately 9:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a quarterly Legal/Non-Compliance visit. LPA was greeted at the door by caregivers Luisita Makalintal and Rachel Espaldon. LPA toured the building and found it to be clean and orderly. Food was plentiful and stored in a safe manner. At approximately 10:15AM, LPA reviewed 5 of 5 resident files. LPA observed 4 of 5 residents, (R1, R2, R4, R5) did not have completed re-appraisals/care plans on file. 2 of 5 residents, (R2, R5) did not have completed Pre-Placement Appraisals on file. 1 of 5 residents, (R1), did not have a completed LIC 602, Physician report on file.
At approximately 11:30AM, LPA reviewed 3 staff files. 3 of 3 files contained evidence of completed First Aid/CPR certification. 3 of 3 staff files did not contain evidence of completed annual training as required by Title 22 regulation.

At approximately 12:40PM, Administrator Madonna Martinez arrived at the facility. Administrator informed LPA that she is working on having resident files digitally. Administrator provided LPA with the completed LIC 602, Physician Report for R1.
Administrator stated all residents have care plans, with only 1 still in process. Administrator will send completed care plans to LPA upon completion.
Administrator will send LPA an updated LIC500, that details hours for Administrative work and hours for providing assistance with residents.
Administrator stated staff training has been completed and will send self certification when records are updated.

No citations issued during today's visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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