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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 01:42:45 PM


Document Has Been Signed on 12/20/2023 01:42 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 DANVILLEFACILITY NUMBER:
075601503
ADMINISTRATOR:OLIVA, JOSEPH ANTHONYFACILITY TYPE:
740
ADDRESS:205 EL PINTO ROADTELEPHONE:
(925) 820-9801
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:36CENSUS: DATE:
12/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Caregiver, Luis UmaliTIME COMPLETED:
01:50 PM
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On this day at around 1:20pm, Licensing Program Analyst A Gomez arrived unannounced to deliver amended copy of the report previously issued on 12/15/2023. LPA met with Caregiver Luis Umali. LPA explained the purpose of the visit. Caregiver notified Administrator and administrator approved caregiver, Luis Umali to sign off on amended report.

LPA provided caregiver a copy of the report.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona GomezTELEPHONE: 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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