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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208838
Report Date: 05/31/2023
Date Signed: 05/31/2023 10:21:48 AM


Document Has Been Signed on 05/31/2023 10:21 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:MAGNOLIA CROSSINGFACILITY NUMBER:
107208838
ADMINISTRATOR:RANCOUR, MANDYFACILITY TYPE:
740
ADDRESS:32 W SIERRA AVETELEPHONE:
(559) 765-4916
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:60CENSUS: 39DATE:
05/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Constance Peters, AdministratorTIME COMPLETED:
10:35 AM
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On 5/31/23 at 9:20 AM, Licensing Program Analyst (LPA) Malia Thao conducted an unannounced case management - other inspection. LPA explained reason for inspection and met with Administrator (ADM) Constance Peters.

During the inspection for complaint #24-AS-20230525082016, LPA found that ADM and S1 was not associated to the facility. ADM began working on 5/22/23 and S1 began working on 5/24/23. Facility completed a transfer of criminal record clearance on the Guardian website for both ADM and S1 during the inspection.

No deficiencies cited during this inspection.

Licensee was present during the beginning of the inspection and advised all paperwork for the change of Administrator will be submitted to CCL within the next 3 weeks. LPA advised the annual renewal fees have not been paid current. Licensee stated he will inform the Director of Operations. LPA advised ADM that the annual renewal fees must be paid within the next 2 weeks.

Exit interview conducted. A copy of this report was given to Administrator, whose signature confirms receipt of this report.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
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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