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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247206554
Report Date: 12/28/2021
Date Signed: 12/28/2021 11:36:37 AM

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:KAZLIN INFINITE CARE LLCFACILITY NUMBER:
247206554
ADMINISTRATOR:ERLINDA MAGLIBAFACILITY TYPE:
740
ADDRESS:3554 EL REDONDO DRIVETELEPHONE:
(209) 349-8457
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:6CENSUS: 6DATE:
12/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Erlinda Magliba, AdministratorTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPAs) Kamaldeep Kaur and Lady Cabrera conducted a Case Management visit to obtained information regarding Resident (R1) On 11/20/2021, Unusual Incident/Injury Report was submitted to Community Care Licensing (CCL) regarding R1 going absent without leave (AWOL) on 11/06/2021. LPAs met with Administrator Erlinda Magliba and stated the purpose of the visit.

LPAs reviewed R1’s Physician’s Report dated 04/28/2021, per report R1 is able to leave unassisted. Administrator reported R1’s conservator notified her that R1 is unable leave facility unassisted as of November 30, 2021. Administrator will update the R1’s Needs and Services report. leave the facility unassisted. Administrator will update the R1’s Needs and Services report.

Exit interview conducted. LPA provided a copy of this report to the Administrator.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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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