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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607448
Report Date: 01/09/2025
Date Signed: 01/09/2025 04:25:19 PM

Document Has Been Signed on 01/09/2025 04:25 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MAGNOLIA TREE BOARD AND CARE HOME, THEFACILITY NUMBER:
300607448
ADMINISTRATOR/
DIRECTOR:
SABIO, MARILOUFACILITY TYPE:
740
ADDRESS:805 E WILSON AVETELEPHONE:
(714) 538-6046
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
01/09/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Marlenie CarazonTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 01/09/2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted by Care Giver (CG) Marlenie Carazon and granted entry to the facility LPA Vanegas advised the purpose of the visit, and began to set up equipment. LPA Vanegas began a tour of the facility and observed the following.

This is a one storied home with five bedrooms two of which are staff rooms and three of witch are client rooms, three bathrooms one of which is a staff bathroom, and two of which are client bathrooms, and a two car detached garage. LPA Vanegas observed the kitchen area to be clean and free of debris and mildew. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non-perishable food as well as a sufficient amount of emergency water on hand. LPA Vanegas observed a dish washer, microwave, gas stove, and refrigerator all were tested and operational and in good repair.

LPA Vanegas observed client bathrooms and all were clean and free of debris and mildew. All bathrooms had required furnishings such as grab bars, slip resistant matts, and shower chairs. Water faucets and toilets tested to be operational and water temperature tested between 124.3 and 125.6 degrees. LPA Vanegas interviewed one staff member and one client.

LPA Vanegas reviewed four client files and two out of four client files had all required documentation two client files were missing the required documents. LPA Vanegas reviewed three staff files and all staff files were missing training documentation and a health screening of staff member Marlenie was missing.

LPA Vanegas advised that due to time constraints LPA would need to end the visit here and come back at a later time to continue the annual inspection. No deficiencies were issued at this time an exit interview was completed and a copy of this report was left at the facility.
Armando J LuceroTELEPHONE: (714) 703-2866
William VanegasTELEPHONE: (714) 497-7621
DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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