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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600154
Report Date: 03/11/2025
Date Signed: 03/11/2025 01:01:12 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/11/2025 01:01 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:MAGNOLIA OF MILLBRAEFACILITY NUMBER:
415600154
ADMINISTRATOR/
DIRECTOR:		LOLA BORREGOFACILITY TYPE:
740
ADDRESS:201 CHADBOURNE AVENUETELEPHONE:
(650) 697-7700
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY: 180TOTAL ENROLLED CHILDREN: 0CENSUS: 109DATE:
03/11/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Assistant Exectutive Director - Charito AmorantoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 03/11/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - annual continuation visit. LPA met with assistant executive director Charito Amoranto and explained the purpose of today's visit.

During today's visit LPA reviewed resident files at random and reviewed medications for residents. Per observations made files are current and medications are current as well.

No citations issued on this day.

LPA reviewed this report with Charioto Amoranto and provided a copy of this report.
April CowanTELEPHONE: (650) 266-8865
Jaime VadoTELEPHONE: (559) 476-9353
DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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