107208838-6-26-2020-24-AS-AXIG-BQXM4R-20200626091709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208838
Report Date: 06/22/2020
Date Signed: 06/26/2020 08:52:10 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/05/2019 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20191105105352

FACILITY NAME:	MAGNOLIA CROSSING		FACILITY NUMBER:	107208838
ADMINISTRATOR:	RANCOUR, MANDY		FACILITY TYPE:	740
ADDRESS:	32 W SIERRA AVE		TELEPHONE:	(559) 765-4897
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93612
CAPACITY:	60	CENSUS: 37	DATE:	06/22/2020
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator Mandy Rancour		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff is involved romantically with a resident.
Staff is failing to meet the needs of a resident.
Staff are financially abusing resident.

INVESTIGATION FINDINGS:

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Consistent with federal guidelines and Executive Order issued by Governor Gavin Newsom to improve infection control and prevent the transmission of COVID-19 to our most vulnerable and high-risk residents, the Department conducted this investigation by phone and correspondence.

On this date Licensing Program Analyst (LPA) K. Mcclurg conducted a telephone interview with Administrator Mandy Rancour. LPA notified Administrator that the purpose of this call was regarding a Complaint investigation.

The Department conducted interviews of residents & staff & record reviews.

Resident 1 (R1) denied having a romantic relationship with staff. Staff denied any knowledge that R1 was romantically involved with staff. There is no documentation to show that staff was involved in a romantic relationship with R1 around the time of the allegation.

Continued.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurg	TELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20191105105352

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MAGNOLIA CROSSING	FACILITY NUMBER: 107208838
	VISIT DATE: 06/22/2020

NARRATIVE

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Continued from Page 1.

Alleged R2 denied having been dropped. Staff denied observing or having knowledge that R2 was dropped. There is no documentation to show that R2 was dropped around the time of this allegation.

R1 denied that staff took their wallet. Staff denies knowledge of R1's wallet being taken. There is no documentation to show that R1's wallet was taken or that staff was financially abusing R1 around the time of this allegation.

The Department has investigated the above allegations. Based on interviews & record reviews, the Department has found the allegations were unfounded

Exit interview conducted with Administrator Mandy Rancour.
Report provided.

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurg	TELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2020

LIC9099 (FAS) - (06/04)

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