507001187-6-9-2021-27-AS-ADGA-C3TNDD-20210609102210

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 507001187
Report Date: 06/09/2021
Date Signed: 06/09/2021 10:22:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	GOLDEN AGE		FACILITY NUMBER:	507001187
ADMINISTRATOR:	MARINELA PLACINTAR		FACILITY TYPE:	740
ADDRESS:	3521 EFFINGHAM LANE		TELEPHONE:	(209) 491-0674
CITY:	MODESTO	STATE: CA	ZIP CODE:	95357
CAPACITY:	6	CENSUS: 6	DATE:	06/09/2021
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Marinela Placintar, Licensee		TIME COMPLETED:	10:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An office meeting was conducted today in the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to discuss audit compliance. Present at the meeting was Regional Manager (RM) Krystall Moore, Licensing Program Manager(s) Stephenie Doub, Licensing Program Analyst (LPA) Arlene Garcia, Jacqueline Juarez and Lisa Ni DSS Auditors, Marinela Placintar Licensee. On November 5, 2020 an Office meeting was held to discuss the audit findings. It was agreed during the Office meeting that the licensee would provide monthly documentation to the audit department for solvency monitoring. The documents required are as follows: · LIC 401 · LIC 402 · Rent roll · Utility statements · Food receipts · Monthly and quarterly bank statements These documents were to be submitted quarterly and were due on April 15, 2021 but have yet to be received by the Department. Cont. 809_C>>>>>>>>>>>>>>>>>>>>>>>>>>

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arlene D Garcia	TELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GOLDEN AGE	FACILITY NUMBER: 507001187
	VISIT DATE: 06/09/2021

NARRATIVE

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Cont. 809-C >>>>>>>>>>>>>>>>>>>>>>>>>

The licensee agreed to the following to remain in compliance:
· Submit outstanding documentation for September 2020 by 6/11/2021
· Provide documentation for 1^st quarter of 2021 (January – March) by 6/30/2021
· Provide documentation for 2^nd quarter of 2021 (April – June) by 7/31/2021
· Provide documentation for 3^rd quarter of 2021 ( July – September) by 10/15/2021

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies were cited. An exit interview was conducted with Licensee Marinela Planticar via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arlene D Garcia	TELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

LIC809 (FAS) - (06/04)

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