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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202569
Report Date: 11/06/2020
Date Signed: 11/06/2020 04:01:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MADONNA GARDENSFACILITY NUMBER:
275202569
ADMINISTRATOR:HELEN HURLEYFACILITY TYPE:
740
ADDRESS:1335 BYRON DRTELEPHONE:
(831) 758-0931
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY:88CENSUS: 44DATE:
11/06/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Patty KingTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Grace Davis conducted Technical Assistance (TA) Covid Case Management tele- Inspection via Facetime. Due to COVID-19 preventive measures, facility visits have been suspended. LPA met with Executive Director Patty King (ED), Resident Care Manager Jeriah Arreola (RCM) and also present is Health Facilities Evaluator Nurse (HFEN) Rebekah Bird Wohlgemuth.

ED stated Memory Care (MC) unit had mass testing on 11/2/2020 and 11/03/2020 for 25 residents and 65 staff and awaiting for results.

At 1 PM, LPA toured the facility with ED, RCM and HFEN nurse. LPA observed COVID-19 posters in conspicuous areas in the facility and screening station with hand sanitizer, paper towel, and screening log sheet. LPA observed that there were COVID related signs inside two staff restroom.LPA observed staff are wearing face shield and mask.

ED stated the dining room are not used, and meals are served at the resident rooms. HFEN stated to consult with the local health department for reopening of the dining.

HFEN nurse recommended to used spindle on paper towels and trash bins with lid and step on. ED agreed and will follow said recommendation. HFEN also recommend to review Donning and Doffing with the staff.
LPA advised ED to continue to communicate with the Monterey County Health for the most recent COVID 19 guidelines.

No deficiencies cited during today's Tele Visit. Exit Interview conducted with ED.
A copy of this report is e-mailed to the facility for signature.
SUPERVISOR'S NAME: Romeo ManzanoTELEPHONE: (408) 324-2112
LICENSING EVALUATOR NAME: Grace DavisTELEPHONE: (408) 314-5102
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020
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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