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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397001473
Report Date: 01/02/2026
Date Signed: 01/02/2026 10:43:42 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
11/17/2025 and conducted by Evaluator Noel Wolf Petersen
COMPLAINT CONTROL NUMBER: 27-AS-20251117151432
FACILITY NAME:J & R MAGSAYO HOMEFACILITY NUMBER:
397001473
ADMINISTRATOR:CHERRYL MAGSAYOFACILITY TYPE:
735
ADDRESS:2452 S. FRESNO AVENUETELEPHONE:
(209) 466-4584
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 5DATE:
01/02/2026
UNANNOUNCEDTIME BEGAN:
05:15 AM
MET WITH:Tor RededtorTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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9
Fire clearance violations
Facility did not get permits from the city or county to add on or build onto the facility.
INVESTIGATION FINDINGS:
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LPA arrived unannounced, to the facility, 1/2/2026, to deliver findings of a complaint investigation. LPA met with the administrator Tor Renedor to explain the purpose of the visit.

LPA reviewed files, the original facility sketch and submitted changes, and found it matched the building in approximation with the current facility sketch. Interview with the fire marshal, the building is not fire cleared. Interviews with the Administrator provided that the changes to the garage in 2013 were permited, but the changes to the staff room were not. LPA updated the fire marshal, Licensee will take steps to follow up until the building is fire cleared.
Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations is being cited on the attached LIC 9099D
Citation issued on following d-page. appeal rights provided. a copy of the report was read and given to staff, exit interview conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026
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 3
Control Number 27-AS-20251117151432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: J & R MAGSAYO HOME
FACILITY NUMBER: 397001473
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/02/2026
Section Cited
CCR
80020(a)
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80020(a) Fire clearance All facilitys Shall secure and maintain a fire clearance approved by the city or county fire department, the district providing protection services, or the state Fire Marshal.
This requirement was not met as evidinced by:
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2
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7
The licensee is working with the department to get a assessment from the stockton fire department, Archetect has been contacted getting a permit for the chanages, submit a new facility sketch with any updates to the LPA,
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14
LPA record review of the facility's file and interview with the fire marshal could not produce a fire clearance for the facility

This presents an immediate health and safety risk to the clients in care.
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and a LIC 200 with a request for a new fire clearance.

Updates will be sent on a monthly basis to noel.wolfpetersen@dss.ca.gov. begining 2/2/2026
Type B
01/02/2026
Section Cited
CCR
80086(c)
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80086 (c) Alterations to Existing Building or New Facilities (c) prior to construction or alterations, state or local law requires that all facilities secure a building permit

This requirement was not met as evidenced by:
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Same as above, get the building fire cleared, update monthly the LPA until it happens.
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14
LPA interview with the administrator where it was learned the staff room updates in 2013 does not have a building permit.

This presents a potential health and saftey risk to clients in care
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14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3