157208940-9-9-2021-24-AS-MHON-C6XMCK-20210917092941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208940
Report Date: 07/22/2021
Date Signed: 09/09/2021 03:20:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/30/2020 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20201230161131

FACILITY NAME:	MAGNOLIA PLACE		FACILITY NUMBER:	157208940
ADMINISTRATOR:	CHAPMAN, MICHAEL		FACILITY TYPE:	740
ADDRESS:	8100 WESTWOLD DRIVE		TELEPHONE:	(661) 663-8400
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	146	CENSUS: 95	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Executive Director, Michael Chapman		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not apprise resident's family of change in resident's condition
Staff did not ensure that resident was adequately fed while in care

INVESTIGATION FINDINGS:

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On 07/22/2021, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to deliver findings on the above allegation.

During the course of the investigation, LPA conducted interviews with staff and reviewed records. LPA received documentation from Executive Director evidencing the family's notification and consent to place R1 on HospiceCare services due to a change of condition for R1.

Facility records reveal annual documented weight records for 2017, 2018 and 2019. Hospital records show R1 is one pound heavier in weight than the three years prior. Facility’s procedures were reviewed. It was confirmed the facility contacted the physican and family to initiate Hospice Care. Based on interviews conducted and records reviewed, the allegation is UNFOUNDED. Therefore we have dismissed the complaint. No deficiency was observed. Exit interview conducted.

No Deficiencies are being cited on todays visit. Exit interview conducted and appeal rights given.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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