107208838-6-26-2020-24-AS-AXIG-BQXLSS-20200626090113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208838
Report Date: 06/25/2020
Date Signed: 06/26/2020 08:50:37 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
10/22/2019 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20191022120501

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:	06/25/2020
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Administrator Mandy Rancour		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff are not properly managing resident's medications
Facility staff are not adequately trained before assisting residents in care
Facility staff is stealing from residents
Facility restricts resident's ability to access toiletries/necessities
Facility is malodorous

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 staff & resident interviews & record reviews.

Continued.

Unsubstantiated

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: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

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
10/22/2019 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20191022120501

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:	06/25/2020
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Administrator Mandy Rancour		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility restircts resident's access to personal items.

INVESTIGATION FINDINGS:

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Stafff denied that resident did not have access to their personal items. Resident denied that access to their personal items was restricted. There is no documentaion to show that access to resident's personal items was restricted around the time of the allegation.

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

Exit interview conducted with Administrator Mandy Rancour.
Report provided.

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: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

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

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 24-AS-20191022120501

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: 06/25/2020

NARRATIVE

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Continued from page 1.

Staff denied having given resident's medication to another resident. There is no documentation to show that resident medication was given to another resident around the time of the allegation.

Staff denied that training had not been provided prior to assisting residents. There is documentation that shows training provided to staff around the time of the allegation.

Staff denied that staff were stealing from residents. There is no documentation to show that staff stole from residents around the time of the allegation.

Staff denied that facility restricted residents from obtaining toiletries, including toilet paper. There is no documentation to show that residents were denied access to necessary toiletries around the time of the allegation.

Staff denied that facility smelled of urine. There is no documentation to show that the facility smelled of urine at the time of the allegation.

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

Exit interview conducted with Administrator Mandy Rancour.
Report provided.

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SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurg	TELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3