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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202569
Report Date: 09/26/2024
Date Signed: 11/13/2024 03:34:39 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20240207162534
FACILITY NAME:MADONNA GARDENSFACILITY NUMBER:
275202569
ADMINISTRATOR:TYLER BRANESFACILITY TYPE:
740
ADDRESS:1335 BYRON DRTELEPHONE:
(831) 758-0931
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY:88CENSUS: 62DATE:
09/26/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Medication Technician, Vanessa Martinez TIME COMPLETED:
08:15 PM
ALLEGATION(S):
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Staff did not prevent a resident from developing a pressure injury while in care.
Facility required an unqualified staff to train other staff.
Facility did not ensure that staff are being properly trained.
Facility administrator did not prevent residents from missing medication doses.
Staff are not properly managing residents medications.
Facility did not ensure residents medical assessment forms are updated.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to open a complaint investigation. LPA met with Medication Technician, Vanessa Martinez, and spoke with Regional Director, Nestor Mendez by phone, and explained the purpose of today's visit.

Regarding the allegation Staff did not prevent a resident from developing a pressure injury while in care. There is no records provided documenting Resident 1 had a pressure injury while in the facilities care. Based on documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/07/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20240207162534

FACILITY NAME:MADONNA GARDENSFACILITY NUMBER:
275202569
ADMINISTRATOR:TYLER BRANESFACILITY TYPE:
740
ADDRESS:1335 BYRON DRTELEPHONE:
(831) 758-0931
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY:88CENSUS: 62DATE:
09/26/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Medication Technician, Vanessa MartinezTIME COMPLETED:
08:15 PM
ALLEGATION(S):
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Staff did not seek medical attention in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to open a complaint investigation. LPA met with facility Medication Technician Vanessa Martinez, Regional Director, Nestor Mendez, and explained the purpose of today's visit.

Regarding the allegation Staff did not seek medical attention in a timely manner. Resident 1 had an ongoing skin condition, and often complained of symptoms related to this condition. Care notes for Resident 1 document there was an ongoing skin condition. Resident 1's physician recommended they see a dermatologist several times beginning on 02/03/2024, 02/09/2024, and again on 02/29/2024. Resident 1 went to the hospital with an infection on 03/05/2024 more than a month after primary care physician recommended the wound be assessed by dermatology. Based on interviews conducted, and records reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 24-AS-20240207162534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MADONNA GARDENS
FACILITY NUMBER: 275202569
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2024
Section Cited
CCR
87465(a)
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87465Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
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Administrator agrees to do In service training in the August health system to remind staff of appointments doctors are seeking for facility residents, and send proof to LPA by POC date of 09/27/2024.
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Resident 1's had ongoing symptoms of a skin condition. Resident 1's Physician recommended they be seen by a dermatologist several times
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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.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 24-AS-20240207162534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MADONNA GARDENS
FACILITY NUMBER: 275202569
VISIT DATE: 09/26/2024
NARRATIVE
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Continued...

Regarding the allegation Facility required an unqualified staff to train other staff. LPA Hurt interviewed two facility medication technicians, both stated they do allow new medication technicians to shadow them as part of the training process. The medication technicians both stated they are instructed during the shadow process not to train as it is only shadowing. The medication technicians stated they do end up answering any questions the newer medication technicians ask, but they are not training new staff. Based on interviews conducted, documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.


Regarding the allegation Facility did not ensure that staff are being properly trained. Staff 1 stated they were given a training course by the facility nurse, and hands on training before assisting any residents with medications. Staff 1 stated they also did shadowing of other facility medication technicians. Based on interviews conducted, documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation Facility administrator did not prevent residents from missing medication doses. LPA Hurt reviewed three assisted living residents Centrally Stored Medication Record, and Medication Administration Record from the months of February 2024. The records document all three residents were administered their medications. Based on interviews conducted, documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20240207162534
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MADONNA GARDENS
FACILITY NUMBER: 275202569
VISIT DATE: 09/26/2024
NARRATIVE
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Continued...

Staff are not properly managing residents’ medications. LPA Hurt reviewed three assisted living residents Centrally Stored Medication Record, and Medication Administration Record from the months of February 2024.The facility staff are assisting residents with their medications. Based on interviews conducted, documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Facility did not ensure residents medical assessment forms are updated. Several facility residents in Assisted Living do not have their Physician's Reports updated annually as is not required. Based on documentation obtained and reviewed during this investigation by Department of Social Services staff this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.


Exit interview conducted with Nestor Valdez and Vanessa Ramirez, and a copy of this report along with appeals rights provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5