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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208940
Report Date: 08/04/2022
Date Signed: 08/04/2022 10:42:51 AM


Document Has Been Signed on 08/04/2022 10:42 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:MAGNOLIA PLACEFACILITY NUMBER:
157208940
ADMINISTRATOR:ANDERSON, PAULFACILITY TYPE:
740
ADDRESS:8100 WESTWOLD DRIVETELEPHONE:
(661) 663-8400
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:146CENSUS: 114DATE:
08/04/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Resident Service Director, Francine Reyes TIME COMPLETED:
11:00 AM
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On 08/04/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management - health checks inspections. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Resident Service Director, Francine Reyes.

The purpose of today's visit is to follow up on an incident report submitted to the Fresno CCL office regarding a possible fire at the facility. LPA conducted a facility tour and observed residents throughout the facility doing daily activities.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Resident Service Director, Francine Reyes, whose signature on this form confirms receipt of this document.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
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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