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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206604
Report Date: 11/15/2021
Date Signed: 11/15/2021 02:46:24 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: 16DATE:
11/15/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Esperanza Hansen, Licensee
Justin Harris, Licensee's Attorney		TIME COMPLETED:
02:00 PM
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On this date, Licensing Program Analyst (LPA) S. Doucette, Licensing Program Managers (LPMs) S. Pidgirny and S. Moua, and Regional Manager (RM) B. White conducted an inspection to the facility.

Pursuant to the State of California, Tulare County Superior Court Docket No. VCU284145, Order Appointing Receiver, the Department discussed with the licensee the status of Magnolia Park Assisted Living facility, located at 2950 E. Douglas Avenue, Visalia, CA 93292 and the execution of the court’s order.

Esperanza Hansen was informed that pursuant to the court’s order, she lost control of the property and as a result, her license is forfeited. Esperanza was also informed that the Department has granted receiver appointed applicant RDE2, LLC an RCFE license effective today. With the issuance of the license to RDE2, Esperanza was informed that she is no longer the licensee of the facility.

A forfeiture of license due to the loss of control of property letter was provided to Esperanza and Justin.

Exit interview was conducted.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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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