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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803822
Report Date: 06/05/2023
Date Signed: 06/05/2023 12:32:50 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/31/2023 and conducted by Evaluator Karina Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20230531105101
FACILITY NAME:MAGNOLIA COURTFACILITY NUMBER:
486803822
ADMINISTRATOR:YOLANDA HARRELLFACILITY TYPE:
740
ADDRESS:1111 ULATIS DRTELEPHONE:
(707) 447-7100
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:146CENSUS: DATE:
06/05/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Yolanda Harrell, Executive DirectorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
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9
Facility failed to meet resident's care needs
INVESTIGATION FINDINGS:
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2
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5
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13
Licensing Program Analyst (LPA) Karina Canela arrived unannounced to open a complaint at Magnolia Court on 06/05/2023. LPA met with Yolanda Harrell, Executive Director. LPA reviewed facility documents and obtained copies. Interviews were conducted and observations were made.
Review of Resident (R1)'s records revealed R1 was admitted on 03/23/2023 to Magnolia Court, R1 was then admitted to Kaiser Permanente Emergency Department on 03/24/2023 and discharged back to Magnolia Court on 05/26/2023. Interviews conducted indicated concerns with the care plan not being followed and neglect of R1 was a complaint made against Kaiser Permanente Hospital, not Magnolia Court. Based on records reviewed and statements received, evidence obtained did not corroborate the allegation against Magnolia Court.
This agency has investigated the complaint alleging "Facility failed to meet resident's care needs". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. **No Citations issued.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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