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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425812
Report Date: 03/12/2025
Date Signed: 03/12/2025 02:45:40 PM

Document Has Been Signed on 03/12/2025 02:45 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:MAGNOLIA RESIDENCEFACILITY NUMBER:
336425812
ADMINISTRATOR/
DIRECTOR:		CANDANEDO, NITZAFACILITY TYPE:
735
ADDRESS:45015 THALIA LANETELEPHONE:
(951) 226-7391
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY: 4CENSUS: 4DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Licensee/Administrator Nitza Candanedo and Administrator Ivan VarelaTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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On 03/12/2025 at 12:15 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to conduct the required comprehensive annual inspection. LPA Brown knocked on the door, pressed the doorbell and LPA walked around the home and did not observe any persons inside the home. At 12:17 PM, a female individual informed LPA Brown via ring camera that they were out in the community but they are driving back to the facility and will be arriving in a few minutes. At 12:37 PM, Licensee/Administrator Nitza Candanedo arrived at the facility and LPA Brown gained access to the home. LPA Brown explained the purpose of today's visit to Licensee/Administrator Nitza Candanedo Administrator Ivan Varela.

The facility is an Adult Residential Facility (ARF) licensed for a capacity of four (4) ambulatory clients. The facility is defined as level 4i home vendorized by Inland Regional Center (IRC). The facility has five (5) bedrooms, three (3) bathrooms, kitchen, dining room, living room, laundry room, attached garage, and a backyard. The current census is four (4) clients. LPA was accompanied by Licensee/Administrator Candanedo and Administrtaor Varela to conduct a general overall inspection, review of records, medications audit and Personal & Incidental (P&I) audit which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed no client during the visit as they were all out in the community. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 68 degrees Fahrenheit. LPA Brown inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs, and sufficient lighting. LPA Brown inspected client bathrooms; bathrooms were clean, and appliances were found functional. Water temperature tested at 112.4 degrees Fahrenheit. The facility is equipped with operational smoke detectors and carbon monoxide detectors, charged fire extinguishers, and first aid kit with first aid book. *** Continuation in LIC809C ***

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: MAGNOLIA RESIDENCE
FACILITY NUMBER: 336425812
VISIT DATE: 03/12/2025
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Posters such as; the personal rights, CCLD complaint poster, emergency disaster plan, and House Rules were posted in a common area. Client medications were kept in locked closet inaccessible to clients. In addition, LPA Brown observed night lights at the hallway leading to clients' shared bathroom. The facility had emergency supplies, emergency food and water. There are no firearms and ammunition in the facility.

Yards/Outside: One shaded patio, one (1) side gate with self-latching handle on the left side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstructions.

Food Service: LPA observed more than two (2) day(s) supply of perishable food and more than seven (7) day(s) supply of non-perishables food and snacks. Dishes, cups, and utensils were stored properly.


Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week.

Record Review: The facility has an updated Infection Control Plan, Emergency Disaster Plan, Liability insurance and Surety Bond. LPA Brown reviewed four (4) client files for admission agreements, medical assessments/physician reports, Individual Program Plan (IPP) and Centrally Stored Medications List/Physician Orders. LPA Brown observed files reviewed were complete. LPA Brown also reviewed staff and administrator's file for First Aid/CPR certification, Emergency Intervention Certification (CPI), criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown observed no issues, files reviewed were complete.

LPA Brown audited two (2) clients’ medications and no issues were observed. LPA Brown audited two (2) clients' P&I and no issues observed.

No deficiency was issued during this visit. An exit interview was conducted where this report LIC809, was discussed, and copies were provided to Licensee/Administrator Nitza Candanedo and Administrator Ivan Varela.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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