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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208838
Report Date: 12/05/2024
Date Signed: 12/05/2024 02:57:46 PM

Document Has Been Signed on 12/05/2024 02:57 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/
DIRECTOR:		PETERS, CONSTANCEFACILITY TYPE:
740
ADDRESS:32 W SIERRA AVETELEPHONE:
(559) 765-4916
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Constance PetersTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 12/5/2024, Licensing Program Analyst (LPA) Daiquiri Boyd made an unannounced visit to the facility for the purpose of conducting a check of the facility and records to verify that an employee is not employed or on the premises.

Individual named Tiana Gilbert AKA Tiana Tiara Ros has not been employed at this facility since January 5, 2024. This individual was only employed at this facility for approximately two weeks in 2023.

CDSS No.7924253001
Sergiy PidgirnyTELEPHONE: (559) 243-8080
Daiquiri BoydTELEPHONE: 559-243-8080
DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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