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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208940
Report Date: 12/06/2024
Date Signed: 12/16/2024 02:48:23 PM

Document Has Been Signed on 12/16/2024 02:48 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MAGNOLIA PLACEFACILITY NUMBER:
157208940
ADMINISTRATOR/
DIRECTOR:		ANDERSON, PAULFACILITY TYPE:
740
ADDRESS:8100 WESTWOLD DRIVETELEPHONE:
(661) 663-8400
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 146TOTAL ENROLLED CHILDREN: 0CENSUS: 120DATE:
12/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Administrator Paul Anderson and Director of Residential Services Shellie WhitlockTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 12/06/24, Licensing Program Analyst (LPA) M. Yang conducted case management- deficiency visit to the facility. LPA introduce self, stated the purpose of the visit and met Administrator Paul Anderson and Director of Residential Services Shellie Whitlock.

The purpose of the visit is to address two incidents that had occurred. The first incident occurred where R1 was last seen in the facility on 11/24/24 at 04:00PM and the facility received a call at 04:30PM that a stranger found the resident near a junior high school.

The second incident occurred on 12/01/24, where the facility received phone call from the hospital that R2 was seen at a gas station and transferred to the hospital.

Therefore, as mentioned, R1 and R2 went AWOL from facility. As a result, a deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D. An immediate civil penalty of $500.00 was issued, see Lic 421IM.

An exit interview was conducted. A copy of this report and appeal rights was provided to Administrator, whose signature confirms receipt of this report.
See MouaTELEPHONE: (559) -65-7912
Mai YangTELEPHONE: 559-772-7402
DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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 12/16/2024 02:48 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
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: 12/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/09/2024
Section Cited
CCR
87411(a)

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87411(a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs….

This requirement is not met as evidenced by:
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Licensee agrees to have AWOL policy and procedures in place to ensure the requirements and submit to Fresno CCL by POC due date 12/09/24.
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Based on interviews and records review, staff did not provide care and supervision when R1 went AWOL on 11/24/24, and facility was not aware until the facility was notified by the neighbors. R2 went AWOL on 12/01/24 and the facility was not aware until the hospital called and informed the facility. R1 and R2 went AWOL poses an immediate health and safety risks to persons 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.
See MouaTELEPHONE: (559) -65-7912
Mai YangTELEPHONE: 559-772-7402

DATE: 12/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2024

LIC809 (FAS) - (06/04)
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