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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202569
Report Date: 12/10/2024
Date Signed: 01/06/2025 02:05:53 PM

Document Has Been Signed on 01/06/2025 02:05 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MADONNA GARDENSFACILITY NUMBER:
275202569
ADMINISTRATOR/
DIRECTOR:
TYLER BRANESFACILITY TYPE:
740
ADDRESS:1335 BYRON DRTELEPHONE:
(831) 758-0931
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY: 88CENSUS: 65DATE:
12/10/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Facility Administrator, Jennifer Vasquez TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced to conduct a Case Management visit. LPA met with Jennifer Vasquez, and explained the purpose of today's visit.


LPA Hurt reviewed an Unusual Incident / Injury Report documenting Resident 1 left the facility and was by the stop sign on the corner when facility staff assisted them back to the facility.

Staff 1 stated they saw Resident 1 near a water fountain outside the facility on her way towards the sidewalk walking away from the facility.

Resident 1 will be reassessed.
Resident 1's Physicians report documents they are able to leave the facility unassisted.
Facility staff will conduct 2 hour checks on Resident 1 to ensure safety.
Facility staff will be 1 on 1 with Resident 1 until they are re assessed as needed.

Technical Assistance provided with Administrator on re assessing Resident 1.


No deficiencies are being cited Per Title 22 Regulations.


Exit interview conducted with facility Administrator Jennifer Vasquez, and a copy of this report along with appeals rights provided
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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