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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208838
Report Date: 02/20/2024
Date Signed: 02/20/2024 04:57:13 PM


Document Has Been Signed on 02/20/2024 04:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:MAGNOLIA CROSSINGFACILITY NUMBER:
107208838
ADMINISTRATOR:PETERS, CONSTANCEFACILITY TYPE:
740
ADDRESS:32 W SIERRA AVETELEPHONE:
(559) 765-4916
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:60CENSUS: 46DATE:
02/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Constance PetersTIME COMPLETED:
05:10 PM
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On 02/20/2024, Licensing Program Analyst (LPA) M. Flores arrived unannounced to conduct a required annual inspection. LPA met with Administrator, Constance Peters and announced the purpose of the visit.

LPA toured the facility inside and out. LPA checked water temperatures in six resident’s bathrooms which read between 112.6- and 119.6-degrees F. LPA observed two fire extinguishers in each home (Poppy, Iris and Sage) and were last service on 04/13/2023. Three kitchens were toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication for Poppy and Iris homes are locked next to the kitchen area in Iris home. Medication for Sage home is locked and located at the back end of the home. LPA observed six bedrooms which were properly furnished, had adequate lighting, and storage space. Smoke detectors and carbon monoxide were last inspected by the Fire Marshall on 2/16/24.

Due to time constraints annual inspection was not completed at this time. No deficiencies and citations were issued at this time. LPA will return to the facility on another date to complete this annual inspection.



Exit interview was conducted with Administrator, Constance Peters.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam FloresTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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