<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803822
Report Date: 04/28/2021
Date Signed: 04/29/2021 11:32:48 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:MAGNOLIA COURTFACILITY NUMBER:
486803822
ADMINISTRATOR:STOUDER, ROBINFACILITY TYPE:
740
ADDRESS:1111 ULATIS DRTELEPHONE:
(707) 447-7100
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:146CENSUS: DATE:
04/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Eric ChristiensenTIME COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4/28/2021 Licensing Program Analyst (LPA) Walters met with Director of Operations, Eric Christensen (EC) and Executive Director, Alma Fuentez (AF) via teleconference in order to conduct a Case Management inspection regarding a self reported incidents of alleged theft at the facility. A tele-visit was conducted due to COVID-19 precautions. The reader is advised that this visit did not take place in person.

On 3/31/2021 it was reported to Community Care Licensing (CCL) that a resident, (R1's) cash was missing from their private residence. R1 alleged the individual who removed the cash from their residence was S1. The Administrator notified Law Enforcement, CCL and the Ombudsman to report the theft. An investigation was conducted by the Director of Operations and Vacaville Police Department. S1 was terminated.

LPA Walters requested additional documents pertaining to this incident be submitted to CCL attention LPA Walters by 4/29/21 COB. LPA conducted exit interview with EC and AF. Report sent to EC for signature.

No deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Katrina WaltersTELEPHONE: (707) 588-5057
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021
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 1