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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426470
Report Date: 09/04/2020
Date Signed: 09/04/2020 03:57:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ATTENTIVE MANORFACILITY NUMBER:
336426470
ADMINISTRATOR:MATTHEW SIEGELFACILITY TYPE:
740
ADDRESS:66-338 FOURTH ST.TELEPHONE:
(760) 251-4330
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY:6CENSUS: 6DATE:
09/04/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Matthew Siegel, AdministratorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Tricia Danielson contacted the facility via telephone for the purpose of addressing concerns which were identified during a concurrent visit at the facility. This visit is being conducted via telephone and Facetime video conference due to COVID-19 and for precautionary measures. LPA met with Administrator (AD) Matthew Siegel.
During today's concurrent complaint investigation visit, LPA discovered Karen Martinez Valenzuela was present and working as a caregiver at the facility. The Department had determined that the presence of Karen Martinez Valenzuela in a facility licensed by the Department of Social Services constitutes a threat to the safety to residents in care, therefore orders the facility to remove Karen Martinez Valenzuela. LPA spoke with Karen Martinez Valenzuela via Facetime at which time Ms. Valenzuela stated her date of birth and social security number. Her stated date of birth and social security number matched the information LPA had on file. LPA inquired as to whether or not Ms. Valenzuela had received a letter from the Department in recent days. Ms. Valenzuela stated she had not. LPA informed Ms. Valenzuela she was not permitted to work at the facility and that she must leave immediately. Via Facetime and facilitated by AD Seigel, LPA observed Ms. Valenzuela gather her purse and personal items, exit the facility, walk to her vehicle and drive away. LPA informed AD Siegel that Ms. Valenzuela had been excluded from being employed in any facility licensed by the Department of Social Services and was not permitted to return to the facility. LPA advised AD that Ms. Valenzuela's employment would be required to be terminated. AD stated he understood the conditions of Karen Martinez Valenzuela's exclusion and would terminate her employment immediately. LPA inquired with AD as to why Ms. Valenzuela was not listed as associated to the facility. AD stated he believed she had been associated and has worked at the facility for about two and a half months. AD stated he would provide LPA with any documents he had which indicated the facility took measures to associate her. AD also provided LPA with Ms. Valenzuela's address listed in their facility file.
An exit interview was conducted with AD via telephone and a copy of this report was provided to AD via email and an electronic email read receipt confirms receipt of this document. AD has also agreed to sign the report and return a copy to LPA via email and/or fax.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2020
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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