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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208940
Report Date: 07/11/2023
Date Signed: 07/11/2023 11:06:51 AM


Document Has Been Signed on 07/11/2023 11:06 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 PLACEFACILITY NUMBER:
157208940
ADMINISTRATOR:ANDERSON, PAULFACILITY TYPE:
740
ADDRESS:8100 WESTWOLD DRIVETELEPHONE:
(661) 663-8400
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:146CENSUS: 125DATE:
07/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Administrator Paul Anderson and Director of Residential Services Shellie WhitlockTIME COMPLETED:
11:15 AM
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On 07/11/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a case management visit. LPA met with Director of Residential Services (DRS) Shellie Whitlock and announced the purpose of the visit. Administrator Paul Anderson arrived shortly.

LPA discuss the Soc 341 that was received by the department on 07/07/23. Administrator was informed by Staff 1 (S1) and Staff 2 (S2) that staff have witnessed Staff 3 (S3) slapping one resident’s wrist, slapping another resident on the back of and pulling another resident’s hair. On 07/10/23, Administrator follow-up to department of incident resulted in the termination of employment of S3. Interview was conducted with DRS who stated internal investigation was completed by 07/08/23 and S3 no longer employed effective 07/08/23. However, the Soc 341 reported received was in relation to the same allegations in complaint 24-AS-20230705155208 received by the department.



The information provide will be reviewed; a follow up case management will be conducted if necessary.

An exit interview was conduct. A copy of this report was provided to Administrator, whose signature on this report confirms receipt of report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023
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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