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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202569
Report Date: 11/02/2020
Date Signed: 11/02/2020 03:50:58 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:
11/02/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Patty KingTIME COMPLETED:
03:25 PM
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Licensing Program Analyst(LPA) Grace Davis, conducted an unannounced Case Management via telephone. Due to COVID-19 preventive measures, facility visits have been suspended. LPA interviewed with Patty King Executive Director (ED).

On 11/02/2020, LPA called the facility and spoke with Executive Director(ED) Patty King. Also present is Brenda Velazquez, Business Office Manager. The purpose of this visit was to obtain additional information on an incident report received by the Department on 10/26/2020 regarding an alleged abuse towards a resident (R1) by a staff (S1).

Per ED, S1 was interviewed and denied the allegation. S1 was taken off from work on 10/19/2020 as a company’s policy while the investigation is on-going.

Per ED's investigation S1 did not push R1 or pulled R1’s hair. ED stated that S1 came back to work on 10/23/2020.

No deficiencies cited during today's Tele Inspection 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: 11/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2020
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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