107208838-5-1-2023-24-AS-BCHN-CRHNX4-20230504105028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208838
Report Date: 04/26/2023
Date Signed: 05/01/2023 03:31:26 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
04/24/2023 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 24-AS-20230424172045

FACILITY NAME:	MAGNOLIA CROSSING		FACILITY NUMBER:	107208838
ADMINISTRATOR:	RANCOUR, MANDY		FACILITY TYPE:	740
ADDRESS:	32 W SIERRA AVE		TELEPHONE:	(559) 765-4916
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93612
CAPACITY:	60	CENSUS: 35	DATE:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator, Lai Saeteurn		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff are restricting residents vistors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the above allegation. LPA Hurt met with facility Administrator Lai Saeteurn and explained the purpose of today's visit.

Regarding the allegation staff are resricting residents vistors. Witness 1 attempted to visit Resident 1 on April 19, 2023 and was told by facility staff he would not be allowed to visit, or speak to Resident 1 without supervision. LPA Hurt spoke with Resident 1 who stated he was ok with Witness 1 visiting him, and he does not want to deny anyone from visiting him. LPA Hurt reviewed the Power of Attorney documents for Resident 1, and there is no section mentioning visitors or restriction of specific visitors.. Resident 1's Power of Attorney has not provided any documents proving anyone is legally ordered to stay away from Resident 1. Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated at this time.

A Technical Violation was issued during todays visit.

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

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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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