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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200309
Report Date: 04/15/2022
Date Signed: 04/15/2022 12:25:55 PM

Document Has Been Signed on 04/15/2022 12:25 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:GLENN VIEWFACILITY NUMBER:
019200309
ADMINISTRATOR:KRISTABELLE ALATASFACILITY TYPE:
735
ADDRESS:38524 GLENVIEW DRIVETELEPHONE:
(510) 894-1971
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 3CENSUS: 0DATE:
04/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:51 AM
MET WITH:Yolanda Alatas Marasigan, Licensee/Administrator
Jonathan Valentino, Staff		TIME COMPLETED:
12:40 PM
NARRATIVE
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On 04/15/22 at 11:51AM, while at the facility for another reason, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced case management and delivered citations to administrator. LPA explained the purpose of the visit with staff (S1) and administrator who authorized S1 to act on her behalf and sign the reports.

Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D:

1. The clients’ P&I funds are well above the current bond. The department’s review of clients’ P&I fund balance show that the current bond is insufficient to provide the necessary protection of clients’ cash resources being held. The bond provision requirement was not being met.

2. In review of the food receipts, the licensee did not spend enough money on food. The amount spent on food for each resident was below the average thrifty plan food cost per person. The general food service requirements provision is not being followed.

3. Based on records and audit reviews. licensee and administrator are not exercising proper oversight of the financial affairs of the facilities. Audit review show multiple utility bills were not paid at all in some months and were past due in others. Licensee had negative bank balances in the months of February and March 2020; which resulted in three incidents of overdraft & return item charges.

4.Based on records and audit reviews, licensee misappropriated the clients’ P&I funds. Review of banking records show the clients’ P&I fund account had legal fees debited by the Franchise Tax Board and court order case fees. Audit review shows clients’ P&I funds are being comingled with other facility accounts. The banking account is shared by the three care homes. For all three facilities, the licensee handles 10 clients’ P&I funds.

Continued on next page, LIC 809-C

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: GLENN VIEW
FACILITY NUMBER: 019200309
VISIT DATE: 04/15/2022
NARRATIVE
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5. Client’s P&I records were not readily available for review. During the department’s facility visits on 1/31/2020, 2/3/2020 and 3/6/2020, P&I records/monies were not available for inspection as well as neutral witness (W1) on official business at the facility on 02/04/2020.

Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided via email.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 04/15/2022 12:25 PM - It Cannot Be Edited


Created By: Daisy Panlilio On 04/15/2022 at 12:03 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
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GLENN VIEW
FACILITY NUMBER: 019200309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2022
Section Cited
CCR
80025(e)

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Whenever the licensing agency determines that the amount of the bond is insufficient to provide necessary protection of clients' cash resources, or whenever the amount of any bond is impaired by any recovery against the bond, the licensing agency shall have the authority to require the licensee to file an additional bond in such amount as the licensing agency determines to be necessary to protect the clients' cash resources.
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POC date, Administrator agrees to submit to CCLD a new affidavit and copy of current bond insurance showing sufficient coverage to safeguard clients’ cash resources.
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This requirement was not met as evidenced by insufficient surety bond coverage which posed a potential health & safety risk to clients in care.
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Type B
04/29/2022
Section Cited
CCR80076(a)(1)

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In facilities providing meals to clients, the following shall apply: All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.…
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By POC date, administrator will submit to CCLD an addendum to the Plan of Operation detailing how the facility will ensure that residents are provided food that is safe and of the quality and quantity necessary to meet their nutritional needs.
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This requirement was not met as evidenced by general food requirements not being met which posed a potential health & safety risk to clients 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.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2022


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/15/2022 12:25 PM - It Cannot Be Edited


Created By: Daisy Panlilio On 04/15/2022 at 12:10 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
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GLENN VIEW
FACILITY NUMBER: 019200309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2022
Section Cited
CCR
80064(a)(4)

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Ability to maintain or supervise the maintenance of financial and other records… This requirement was not met as evidenced by
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By POC date, administrator will submit to CCLD a detailed and adequate financial plan which shows proper management of monthly utility bills to keep them current as well as proof of bank funds sufficient enough to avoid overdrafts and return item charges.
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licensee and administrator are not exercising proper oversight of the financial affairs of the facilitieshich posed a potential health & safety risk to clients in care.
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Type B
04/29/2022
Section Cited
CCR80026(e)

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Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash…
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By POC date, administrator will submit to CCLD an addendum to the Plan of Operation that clearly shows how P & I funds will be properly managed & not commingled with other facility accounts.
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This requirement was not met as evidenced by licensee misappropriated the clients’ P&I funds which posed a potential health & safety risk to clients 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.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/15/2022 12:26 PM - It Cannot Be Edited


Created By: Daisy Panlilio On 04/15/2022 at 12:15 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
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: GLENN VIEW
FACILITY NUMBER: 019200309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2022
Section Cited
CCR
80070(d)

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All client records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours…This requirement was not met as evidenced by
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By POC date, administrator will submit to CCLD an addendum to the Plan of Operation that shows all client records shall be available at the facility for the licensing agency to inspect, audit and copy upon demand.
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Client’s P&I records were not readily available for review which posed a potential health & safety risk to clients 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.
SUPERVISOR'S NAME:Bennett Fong
LICENSING EVALUATOR NAME:Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2022


LIC809 (FAS) - (06/04)
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