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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208880
Report Date: 01/22/2024
Date Signed: 01/24/2024 02:36:22 PM

Document Has Been Signed on 01/24/2024 02:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PEOPLE'S CARE MARLINFACILITY NUMBER:
547208880
ADMINISTRATOR:ALLEN, TARAFACILITY TYPE:
735
ADDRESS:12744 MARLIN AVETELEPHONE:
(559) 372-8827
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 4DATE:
01/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:44 PM
MET WITH:Jose Marquez, District Manager
Yadira Gamez, Asst Administrator
Erinique Jones, Quality Assurance Specialist		TIME COMPLETED:
05:30 PM
NARRATIVE
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On 01/17/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a case management visit based on a self reported incident dated 01/16/24. LPA was greeted by Staff S1, who contacted Asst Administrator, Yadira Gamez. LPA stated the purpose of the visit and was allowed entry into the facility.

LPA met with Asst. Admin, District Manager (DM) Jose Marquez, and Quality Assurance Specialist, Erinique Jones. As of 01/12/24, Tara Allen is no longer the Administrator.

On 12/29/23, a self reported incident was received for Resident R1 stating the NOC staff observed the PM medication was missed. Pharmacy was contacted and facility staff continued to monitor R1 for 48 observation hours. R1 declined the option for medical treatment. No adverse reaction was observed.

On 01/15/24, DM requested an audit be conducted for P&I records for all resident, as there were discrepancies in the ledgers. Audit confirmed that resident's P&I money for 3 out of 4 residents in care, will need to be replaced. Licensee is reimbursing money to all residents affected upon completion of comprehensive audit. DM will provide LPA with audit findings by POC date of 02/23/24.

Based on today’s visit, and per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D.

An exit interview was conducted with District Manager and Quality Assurance Specialist. A plan of correction was developed by and reviewed with LPA. A copy of this report and appeal rights were discussed and provided by email 01/23/24.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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Document Has Been Signed on 01/24/2024 02:36 PM - It Cannot Be Edited


Created By: Lisa Salazar On 01/22/2024 at 04:58 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: PEOPLE'S CARE MARLIN
FACILITY NUMBER: 547208880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2024
Section Cited
CCR
80064(a)(4)

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80064 Administrator - Qualifications and Duties
(a) The administrator shall have the following qualifications: (4) Ability to maintain or supervise the maintenance of financial and other records. This requirement was not met as evidenced by LPA's interview with DM stating it is the Administrator's responsibility to manage the resident's P&I money.
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Administrator Tara Allen was put on Administrative leave and has since resigned. DM will ensure new Administrator has read and understands the qualifications/duties of the Administrator, by signing the CCR Title 22 regulation 80064, that is being provided by LPA with the report. DM will send a copy of signed regulation to LPA via email.
Type B
01/23/2024
Section Cited
CCR
80026(e)

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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(e) Cash resources, personal property, and valuables of clients shall be separate and intact...This requirement was not met as evidenced by LPA's records review of a self reported incident of discrepancies in P&I ledgers that were found while conducting a P&I audit of the facility's safe.
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Audit has been conducted. Licensee will be reimbursing resident's P&I accounts and will provide LPA with completed audit findings. A new quality assurance plan has been implemented and staff training is scheduled for Consumer P&I Management.
Type B
01/23/2024
Section Cited
CCR80075(b)

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80075 Health Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.This requirement was not met as evidenced by LPAs observation of self reported incident report of a missed dose of medication for R1.
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A med audit was conducted. Staff on every shift was trained how to conduct a med audit and med pass. Medication times are posted and medication training with a skilled professional has been scheduled.
**POC CLEARED**

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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.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2024


LIC809 (FAS) - (06/04)
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