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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208940
Report Date: 07/22/2025
Date Signed: 07/30/2025 10:01:47 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250514165227
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: 113DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH: Administrator Mike Chapman and Director Resident Services Mandy HouseTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not seek timely medical attention for resident’s fracture which resulted from an unwitnessed fall
INVESTIGATION FINDINGS:
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On 07/22/25, Licensing Program Analyst (LPA) Yang arrived unannounced to deliver complaint findings on the above allegation. LPA introduced self, stated the purpose visit, and met with Administrator Mike Chapman and Director Resident Services Mandy House.

During the course of the investigation, the Department conducted interviews and reviewed records and based on review, the preponderance of evidence standard has been met, therefore the allegation alleging staff did not seek timely medical attention for resident’s fracture which resulted from an unwitnessed fall is SUBSTANTIATED. Based on records reviewed and interviews conducted, R1 had an unwitnessed fall and sustained fracture. R1 was taken to Urgent Care on 5/5/25 and returned to the facility. From 5/5/25 to 5/8/25, R1 complained of pain as documented on the facility’s progress report. No medical attention was sought until staff called emergency services on 5/13/25. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. The issuance of additional civil penalties is pending and currently under review. The details of additional civil penalties will be outlined in a future report to the facility, if any. Exit Interview conducted. Appeal Rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 24-AS-20250514165227
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MAGNOLIA PLACE
FACILITY NUMBER: 157208940
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/23/2025
Section Cited
CCR
87411(d)(5)
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87411(d)(5) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (5) Knowledge necessary in order to recognize early signs of illness and the need for professional help.

This requirement was not met:
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Licensee will submit a written plan to include when to contact medical attention timely for resident’s care and also will include date of when all staff in-service training including Administrator will be scheduled and completed. Written plan will be submitted to Fresno CCL by POC due date and all staff in-service training materials and rooster will be submitted to the department immediately after trainings has been completed in written plan.
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Based on interviews and records reviewed, staff did not seek medical attention timely for resident’s fracture with resulted from an unwitnessed fall, after R1 complained of pain, which poses an immediate health and safety and personal rights risk to the person 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.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250514165227

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: 113DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH: Administrator Mike Chapman and Director Resident Services Mandy HouseTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Staff did not provide adequate supervision resulting in resident missing their medication dosage
Staff withheld medication from resident without authorization
INVESTIGATION FINDINGS:
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On 07/22/25, Licensing Program Analyst (LPA) Yang arrived unannounced to deliver complaint findings on the above allegations. LPA introduced self, stated the purpose visit, and met with Administrator Mike Chapman and Director Resident Services Mandy House.

During the course of the investigation, the department conducted interviews, toured the facility, and reviewed records. Based on records reviewed and interviews conducted, staff administered medications to each resident and documents medication administration. Medications are withheld with physician’s order therefore the preponderance of evidence standard has not been met, therefore, the above allegation are found to be UNSUBTANTIATED. An exit interview was conducted. A copy of this report was provided to the Administrator, whose signature on this form confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3