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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201415
Report Date: 12/16/2024
Date Signed: 12/16/2024 11:41:44 AM

Document Has Been Signed on 12/16/2024 11:41 AM - 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 ASSISTED LIVINGFACILITY NUMBER:
079201415
ADMINISTRATOR/
DIRECTOR:		OLIVA, JOSEPH ANTHONYFACILITY TYPE:
740
ADDRESS:205 EL PINTO ROADTELEPHONE:
(510) 364-5158
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 36CENSUS: 19DATE:
12/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:
Applicant, Alphie De Guzman		TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 12/16/2024 at 9:00AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a second unannounced pre-licensing visit. LPA met with Backup Administrator, Heidi Yrreverre and explained the purpose of the visit. Applicant, Alphie De Guzman arrived at 10:00AM. The facility currently has 19 residents and is approved for 4 bedridden.

LPA inspected the issues that were noted during the first pre-licensing visit. All issues are corrected and observed. LPA is requesting that facility sends an updated facility sketch to reflect the rooms being utilized by staff.


No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator and a copy of this report provided.

COMP III will be conducted

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Alona Gomez
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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