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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830861
Report Date: 11/15/2024
Date Signed: 11/15/2024 12:58:02 PM

Document Has Been Signed on 11/15/2024 12:58 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FSA-MAGNOLIA CDCFACILITY NUMBER:
334830861
ADMINISTRATOR/
DIRECTOR:
ALONDRA DOMINGUEZFACILITY TYPE:
830
ADDRESS:8172 MAGNOLIA AVE.TELEPHONE:
(951) 353-0129
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 14DATE:
11/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Vanessa JaraTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 11/08/2024 and indicates facility renovations will take place between 11/05/24 and 12/15/2024. The LPAs were greeted by Site Director, Vanessa Jara and granted entry into the facility. LPAs toured the facility and took census.

Facility records were reviewed, photos were obtained, and a tour of the facility was completed. Tour of facility revealed in preschool room 2, the new cabinets have equivalent dimensions to old cabinets and do not affect current square footage. Regarding the kitchen, renovations are still in progress however facility has food delivered from Chefables delivery service. and menus were observed to be current.

Based on information gathered, the facility acted appropriately, and no violations have been identified. Facility completed reporting requirements and submitted an Unusual Incident Report (UIR) as required per CCR Title 22 Division 12 regulations. Facility notified authorized representatives timely but did not notify the department until after renovations began. See LIC9102 technical advisory.

An exit interview was conducted, and a copy of this report, appeal rights and notice of site visit were provided to facility representative, Vanessa Jara.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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