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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700479
Report Date: 12/05/2024
Date Signed: 12/05/2024 02:58:53 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/04/2024 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 59-AS-20241204122848
FACILITY NAME:MAGNOLIA ELDERLY CARE HOMEFACILITY NUMBER:
342700479
ADMINISTRATOR:CRISAN, ADELAFACILITY TYPE:
740
ADDRESS:7797 MAGNOLIA AVETELEPHONE:
(916) 965-7002
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 5DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Adela Crisan, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Facility staff serve poor quality food
INVESTIGATION FINDINGS:
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13
Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility and met with Administrator, Adela Crisan, to open a complaint investigation into the allegation written above. During today's visit, LPAs toured the care home and interviewed staff and residents.

LPAs observed a two (2) day perishable and seven (7) day nonperishable food supply on cite with good quality foods. LPAs also conducted an inspection of the care home on 12/3/2024 and observed a two (2) day perishable and seven (7) day nonperishable food supply on cite with good quality foods. Interviews with residents R1, R2, R3, and R4 indicated that they were satisfied with food service at the facility.

** Report continued on 9099-C **
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 59-AS-20241204122848
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MAGNOLIA ELDERLY CARE HOME
FACILITY NUMBER: 342700479
VISIT DATE: 12/05/2024
NARRATIVE
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Based on interviews conducted and LPAs' observations, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2