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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208838
Report Date: 10/01/2024
Date Signed: 10/01/2024 12:31:24 PM


Document Has Been Signed on 10/01/2024 12:31 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: 41DATE:
10/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Constance PetersTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Daiquiri Boyd made an unannounced visit to the facility and met with Administrator Constance Peters. The purpose of this visit was to discuss an incident reported to Licensing on September 26, 2024. LPA Boyd arrived at the facility at 8:40 AM and staff advised LPA that they will call Administrator, staff advised that Administrator is on her way.

The Incident Report provided to Licensing stated that a staff used inappropriate language when speaking to a resident in care. Additional information in the form of a copy of a letter that was sent to the employee, stating that they were releasing her and she was being terminated.

LPA reviewed the terminated staff's file, which included the training records and a signed copy of the Resident Rights. Administrator told LPA that they had completed an investigation of the staff as soon as the allegation had come to their attention. Administrator stated that, although she was unable to determine if the events had occurred, she felt it was best policy to terminate the staff, as they do not condone this type of behavior.

LPA interviewed staff mentioned in the Incident Report submitted to Licensing. In addition to speaking with Administrator, three staff were interviewed in person and one was called on the phone, and terminated staff was called as well; all during my visit.

LPA conducted exit interview with Administrator.

Citation issued on this day for personal rights violation.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 243-8080
LICENSING EVALUATOR NAME: Daiquiri BoydTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024
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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Document Has Been Signed on 10/01/2024 12:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: MAGNOLIA CROSSING
FACILITY NUMBER: 107208838

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/15/2024
Section Cited
CCR
80072(a)(3)

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Personal Rights-80072 (a)(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coersion, threat, mental abuse, or other actions of a punitive nature...This requirement has not been met as evidenced by:
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Licensee to conduct a "Personal Rights" re-training with all staff. This training is to be completed by October 15, 2024. Proof of re-training is to be emailed to Licensing. "Proof" is topic/subject matter discussed and a sign-in sheet of those in attendance.
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Staff 1 speaking inappropriately to resident by calling resident a "fucking bitch", which poses a potential immediate health, safety, or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 243-8080
LICENSING EVALUATOR NAME: Daiquiri BoydTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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