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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
075601503
Report Date:
12/20/2023
Date Signed:
12/20/2023 03:07:06 PM
Document Has Been Signed on
12/20/2023 03:07 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
OAKLAND ASC
,
1515 CLAY STREET, STE. 310
OAKLAND
,
CA
94612
FACILITY NAME:
MAGNOLIA GARDEN AT DANVILLE
FACILITY NUMBER:
075601503
ADMINISTRATOR:
OLIVA, JOSEPH ANTHONY
FACILITY TYPE:
740
ADDRESS:
205 EL PINTO ROAD
TELEPHONE:
(925) 820-9801
CITY:
DANVILLE
STATE:
CA
ZIP CODE:
94526
CAPACITY:
36
CENSUS:
20
DATE:
12/20/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:00 PM
MET WITH:
Caregiver Virgilio Aquino
TIME COMPLETED:
03:20 PM
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On this day at around 2:50pm Licensing Program Analyst A Gomez arrived unannounced to deliver amended copy of the report previously issued on 12/15/2023. LPA met with caregiver Virgilio Aquino to explain the purpose of the visit and deliver the report.
LPA provided caregiver a copy of the report
SUPERVISOR'S NAME:
Yvonne Flores-Larios
TELEPHONE:
(510) -28-0517
LICENSING EVALUATOR NAME:
Alona Gomez
TELEPHONE:
510-239-1306
LICENSING EVALUATOR SIGNATURE:
DATE:
12/20/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/20/2023
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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