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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507001187
Report Date: 07/21/2021
Date Signed: 08/23/2021 08:25:43 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 AGEFACILITY NUMBER:
507001187
ADMINISTRATOR:MARINELA PLACINTARFACILITY TYPE:
740
ADDRESS:3521 EFFINGHAM LANETELEPHONE:
(209) 491-0674
CITY:MODESTOSTATE: CAZIP CODE:
95357
CAPACITY:6CENSUS: 6DATE:
07/21/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Marinela Placintar, LicenseeTIME COMPLETED:
02:25 PM
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An office meeting was conducted today in the Sacramento Regional Office via WebEx. The purpose of this meeting was to discuss audit compliance. Present at the meeting was Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Stephenie Doub, Jacqueline Juarez and Lisa Ni, DSS Auditors, and 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
The Licensee furnished documents for the 3rd quarter of 2020 which showed non-sufficient fund payments, water bills not paid timely and food costs below the required food requirements. The Licensee agreed that payments may have been late in 2020, but that she has corrected the problem by setting up automatic payments for the accounts. The licensee further explained that all food receipts may not have been provided, which may be the reason for the low food costs.
It was agreed that to better understand the financial solvency of the facility, the licensee would provide all requested documents for the 2nd quarter of 2021 (April, May and June) to DSS Audits section by July 31, 2021.Tthe Licensee was encouraged to reach out to the Department should there be any questions regarding receipts to submit. An exit interview was conducted with Licensee Marinela Placintar and copy of this report was provided via email.
SUPERVISOR'S NAME: Krystall MooreTELEPHONE: (916) 263-4707
LICENSING EVALUATOR NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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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