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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209501
Report Date: 09/15/2026
Date Signed: 09/15/2026 12:20:27 PM

Document Has Been Signed on 09/15/2026 12:20 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
FRESNO RO, 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: 5DATE:
09/15/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:46 AM
MET WITH:administrator Nora Sanchez TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On 09/15/2026, Licensing Program Analyst (LPA) V Gorban arrived unannounced for an Annual Required Inspection. LPA met with acre giver Mae Gillermo. LPA stated the purpose of the visit and was allowed entry. LPA toured the facility conducting health and safety checks with care giver. Administrator Nora Sanchez was notified of licensing visit, certification number 6035114740 and expiration date 6/6/28

Facility has one main entrance/exit point. Facility appeared clean with no obstruction or fire clearance issues. Facility extinguisher service date recorded on 01/10/2026. Last recorded disaster drill conducted on August 12th, 2025. The facility is a single story building with six bedrooms. Shower supplied with a non-slip mat and water temperature observed within regulation. Bathrooms have trash cans with lid. Laundry room observed operational with access to staff only.
The exterior tour was conducted. Back yard observed with emergency exit door and a set furniture accessible to residents in care.

LPA toured the kitchen and observed refrigerator reading of 36 degrees F and freezer with reading of 1 degrees F. Perishable and nonperishable food reviewed by facility staff for expiration and freshness.

Cleaning and PPE supplies were checked in storage outside and locked. LPA reviewed infection control plan and emergency disaster plan. Emergency/ disaster drill is missing.

Staff records were reviewed for good health and infection control training. Facility staff was observed being present and available to residents. Resident’s files reviewed for updated required information.

Deficiency observed and cited on attached LIC809-D.
Exit interview was conducted, report signed and with appeal rights provided for facility records.
Shawna Doucette
Vadim Gorban
DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/15/2026 12:20 PM - It Cannot Be Edited


Created By: Vadim Gorban On 09/15/2026 at 11:05 AM
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: 09/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2026
Section Cited
CCR
87212(b)(2)(A)

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(b) The plan shall be subject to review by the Department and shall include:
(1) Designation of administrative authority and staff assignments(2) Plan for evacuation including: (A) Fire safety plan. This requirement was not observed as evidenced by:
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Licensee will review, conduct and record emergency disaster drill according to Lice sing regulations. Proof of Correction will be provided to LPA by email by POC due date.
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Licensee failed to ensure emergency disaster drill is conducted and recorded follow ing regulations, which poses potential health and safety risk to persons in care
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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.
Shawna Doucette
NAME OF LICENSING PROGRAM MANAGER:
Vadim Gorban
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2026


LIC809 (FAS) - (06/04)
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