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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206604
Report Date: 06/19/2020
Date Signed: 06/19/2020 03:49:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MAGNOLIA PARK ASSISTED LIVINGFACILITY NUMBER:
547206604
ADMINISTRATOR:GONZALEZ, ARNULFOFACILITY TYPE:
740
ADDRESS:2950 E. DOUGLAS AVE.TELEPHONE:
(559) 625-6001
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:48CENSUS: 25DATE:
06/19/2020
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee Esperanza Hansen & Attorney Justin D. Harris TIME COMPLETED:
04:00 PM
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An announced Informal Office visit was conducted on the date & during the times indicated above.
Persons in attendance: Regional Manager (RM) Brenda White; Licensing Program Manager (LPM) Andy Xiong; Licensing Program Analyst (LPA) Kelly McClurg; Licensee Esperanza Hansen & Attorney Justin D. Harris.


The purpose of this visit is to review the current status of this facility.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2020
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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