275202569-3-25-2021-26-AS-RMAO-BZKLUX-20210329090436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202569
Report Date: 03/25/2021
Date Signed: 03/25/2021 04:30:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2021 and conducted by Evaluator Gladys Kuizon

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20210311155133

FACILITY NAME:	CAREFIELD AT MADONNA GARDENS		FACILITY NUMBER:	275202569
ADMINISTRATOR:	PATRICIA KING		FACILITY TYPE:	740
ADDRESS:	1335 BYRON DR		TELEPHONE:	(831) 758-0931
CITY:	SALINAS	STATE: CA	ZIP CODE:	93901
CAPACITY:	88	CENSUS: 44	DATE:	03/25/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Patricia King		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility Administrator does not meet administrator certification requirements.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gladys Kuizon conducted an initial complaint investigation tele-visit today and met with Executive Director (ED) Patricia King. Due to COVID-19 restrictions, physical visits have been suspended.

LPA interviewed ED. According to ED her Residential Care Facility for the Elderly (RCFE) Administrator Certification expired on 02/22/2021. ED completed all recertification requirements before 02/22/2021 and mailed renewal documents to Community Care Licensing Division (CCLD) on 02/11/2021.

LPA reviewed ED's recertification application which showed 80 hours of continuing education completed as of 02/03/2021 and provided by Senior Community Learning (RCFE Vendor# 2000545-740-2). Application also included required fees.

Continued, see LIC 9099-C, page 2 of 2.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys Kuizon	TELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20210311155133

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: CAREFIELD AT MADONNA GARDENS	FACILITY NUMBER: 275202569
	VISIT DATE: 03/25/2021

NARRATIVE

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CCLD records also showed ED has a valid RCFE Administrator Certification from 02/23/2019 through 02/22/2021.

On 03/25/2021, LPA verified status of ED's recertification application with the Department's Administrator Certification Section (ACS). ACS confirmed receipt of ED's application on 02/17/2021. ACS is currently processing applications received on the week on 01/04/2021 and stated ED's application is in queue to be processed as received.

This Department has investigated this allegation. Based on interviews conducted, records reviewed and LPAs observation, the Department has found that this allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An electronic copy of this report was provided to ED for signature.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Gladys Kuizon	TELEPHONE: (408) 834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

LIC9099 (FAS) - (06/04)

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