<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201415
Report Date: 12/16/2024
Date Signed: 12/16/2024 11:40:53 AM

Document Has Been Signed on 12/16/2024 11:40 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:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Applicant, Alphie De GuzmanTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An announced Pre-licensing Comp III associated with Pre-Licensing Inspection done on 12/16/2024 at 11:00 AM was conducted by Licensing Program Analyst (LPA) A Gomez. Comp III was attended by Applicant, Alphie De Guzman.

LPA concluded Comp III.

No citation made during this visit. Exit interview conducted and a copy of this report provided.
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)
Page: 1 of 1