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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206604
Report Date: 10/12/2021
Date Signed: 10/12/2021 01:22:33 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:59CENSUS: 21DATE:
10/12/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Administrator, Arnulfo GonzalezTIME COMPLETED:
01:20 PM
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On 10/12/2021, Licensing Program Analyst (LPA) arrived unannounced to conduct an Case Management - Health and Safety Check for residents in care. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted the Administrator via telephone. LPA met with Administrator, Arnulfo Gonzalez, who arrived a short time later.

Upon entering the facility, LPA observed 7 residents in the dining area eating lunch. LPA conducted a facility tour with Administrator. Facility temperature is at a comfortable temperature. Per Administrator, temperature is set at 75 degrees F. LPA observed utilities services and electricity services to be functioning. LPA observed a sufficient supply of perishable and non-perishable foods during this inspection. During the tour of the facility, LPA observed residents to be watching television, resting in bedrooms, and dining.

No immediate health or safety concerns were observed during this inspection.

No deficiencies observed.

An exit interview was conducted with Administrator. A copy of this signed report will be provided to Administrator via email, due to COVID-19 precautionary measures, and an electronic read receipt confirms receiving this document. Report signed on-site by Facility Representative.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
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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