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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202880
Report Date: 07/24/2024
Date Signed: 07/24/2024 12:37:02 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2024 and conducted by Evaluator Maria Partoza
COMPLAINT CONTROL NUMBER: 26-AS-20240715162930
FACILITY NAME:MARCEL'S MEMORY CAREFACILITY NUMBER:
435202880
ADMINISTRATOR:PENDAR, MARIEFACILITY TYPE:
740
ADDRESS:373 BAY STTELEPHONE:
(480) 578-6785
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:6CENSUS: 3DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Marie PendarTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff in the premises without fingerprint clearance
INVESTIGATION FINDINGS:
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On 7/24/2024 at 9:15 a.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza and Marcela Yanez, conducted an unannounced complaint investigation regarding the above allegation that a staff (S1) was not fingerprinted. LPAs met with adminstrator (ADM) Marie Pendar. LPAs stated the purpose of the visit.

The facility is a Residential Care Facility for the Elderly (RCFE) serves adults from 60 years old and above, approved for 6 non-ambulatory and 6 hospice waiver.

Based on interview and record review and interview, ADM submitted required forms to Guardian, due to typographical errors, Guardian was not able to process the application. ADM was able to clear the confusion with Guardian and ADM was asked to resubmit the application and provided a PIN to expedite the application.

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Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 26-AS-20240715162930
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: MARCEL'S MEMORY CARE
FACILITY NUMBER: 435202880
VISIT DATE: 07/24/2024
NARRATIVE
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Based on document review - S1 has a valid fingerprint clearance dated 3/01/2024. The facility number was not correct. During the time of the visit the ADM was able to resolve the problem with Guardian and have corrected the information based on the instruction received by ADM from Guardian.

This agency has investigated the complaint alleging staff does not have fingerprint clearance. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No citation was issued during today's visit based on California Code of Regulation (CCR) Title 22. A copy of the report was provided to administrator, Marie Pendar.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
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