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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209351
Report Date: 08/29/2023
Date Signed: 08/29/2023 11:03:19 AM

Document Has Been Signed on 08/29/2023 11:03 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 SPRINGS-SUTTONFACILITY NUMBER:
157209351
ADMINISTRATOR:HOUCK, HELENFACILITY TYPE:
735
ADDRESS:2200 SUTTON PLACETELEPHONE:
(661) 664-7758
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
08/29/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Helen HouckTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Shawna Doucette arrived to the facility announced to conduct the Pre licensing visit. LPA Shawna Doucette met with Administrator Helen Houck who granted LPA's entry into the facility.

LPA toured facility. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. Hot water temperature in bathrooms measured at 109 degrees F. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Kitchen observed to have dishes, plates, utensils. Cleaning supplies are stored in a locking cabinet in the bathroom and kitchen. Medications are locked in a medication cabinet. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 5/15/23. Fire alarm has a complete panel for carbon monoxide and residence has a sprinkler system. Facility needs a cover for the fireplace.

Outside of the facility toured. Exits open free of obstruction and no outside hazards were observed. Facility has a pool that is locked and gated inaccessible to clients in care.

All required postings are posted. Facility phone number will be (661) 827-1362.

Component III was conducted during pre-licensing visit with Applicants.

I have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

A copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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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