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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006342
Report Date: 01/10/2025
Date Signed: 01/10/2025 12:44:02 PM

Document Has Been Signed on 01/10/2025 12:44 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MARIGOLD BOARD AND CAREFACILITY NUMBER:
306006342
ADMINISTRATOR/
DIRECTOR:		TRANAE QUATICE GATLINFACILITY TYPE:
740
ADDRESS:8601 SAN ROMOLO WAYTELEPHONE:
(661) 236-6787
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
01/10/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:01 PM
MET WITH:Tranae Gatlin, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Hanna Gough made an unannounced visit to the facility for the purpose of conducting a case management inspection documenting a deficiency observed during the investigation of complaint reference 22-AS-20241231115747.

During the initial complaint investigation, facility staff was unable to provide proof of background clearance for staff member S1, who was stated to have been recently hired to work at the facility. S1 could also not be located in Guardian by licensing staff. As a result, a type A deficiency is being cited along with an immediate civil penalty.

An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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 01/10/2025 12:44 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 01/10/2025 at 12:18 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MARIGOLD BOARD AND CARE
FACILITY NUMBER: 306006342

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/11/2025
Section Cited
CCR
87355(e)(1)

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Per CCR Section 87355(e)(1) regarding Criminial Record Clearance: "All individuals subject to a criminal record review (...) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance (...)". This requirement is not met as evidenced by:
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Staff member S1 instructed to leave the premises and confirmed to have been removed by licensing staff. Licensee will submit a fingerprinting application or proof of a valid background clearance to LPAs.
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Based on records review, facility staff was unable to provide proof of a background clearance for one staff member present on the premises. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.
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IMMEDIATE CIVIL PENALTY ASSESSED.

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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:Sheila Santos
LICENSING EVALUATOR NAME:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2025


LIC809 (FAS) - (06/04)
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