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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208838
Report Date: 05/24/2021
Date Signed: 05/24/2021 06:14:18 PM



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
11/09/2020 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20201109115706
FACILITY NAME:MAGNOLIA CROSSINGFACILITY NUMBER:
107208838
ADMINISTRATOR:RANCOUR, MANDYFACILITY TYPE:
740
ADDRESS:32 W SIERRA AVETELEPHONE:
(559) 765-4916
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:60CENSUS: 36DATE:
05/24/2021
UNANNOUNCEDTIME BEGAN:
03:58 PM
MET WITH:Administrator, Frances HernandezTIME COMPLETED:
05:59 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yell at residents in care.
Staff rough handle residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/24/2021 Licensing Program Analyst (LPA) M. Garza conducted complaint investigation visit with the facility Administrator, Frances Hernandez to discuss complaint findings. Allegations were reviewed with Frances.

The Department investigated the above allegation. Based on interviews (staff and resident) and records review (Physicians Reports, Special incident reports, staff schedules, staff and resident roster with contact information and written statements), although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations occurred. Therefore, the allegations above are found to be UNSUBSTANTIATED. Exit interview completed and appeal rights given.

A copy of the complaint investigation report was sent via email for signature. A delivery and read receipt were sent to serve as confirmation of reciept.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
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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