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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206604
Report Date: 10/14/2021
Date Signed: 10/14/2021 11:36:26 AM

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: 20DATE:
10/14/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Esperanza Hansen; Administrator Arnulfo Gonzalez; Attorney
Justin D. Harris; 		TIME COMPLETED:
12:00 PM
NARRATIVE
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A scheduled Office visit was conducted on the date & during the times indicated above.

Present during the meeting:
  • Esperanza Hansen, Licensee (L);
  • Arnulfo Gonzalez, Administrator (Admin);
  • Justin D Harris, Attorney (Atty);
  • Jacqueline Juarez, Audit Manager; Community Care Licensing (CCL) - present through Microsoft Teams
  • Brenda White, Regional Manager (RM); CCL;
  • See Moua, Licensing Program Manager (LPM); CCL;
  • Sergiy Pidgirny, Licensing Program Manager (LPM); CCL;
  • Kelly McClurg, Licensing Program Analyst (LPA); CCL



Continued.

SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MAGNOLIA PARK ASSISTED LIVING
FACILITY NUMBER: 547206604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/15/2021
Section Cited

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Finances: The Licensee shall have a financial plan that…assures sufficient resources to meet operating cost for care of resident of residents.
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The licensee failed and did not meet this requirement based on records obtained and reviewed during the solvency audit that the facility charged and billed for prepaid rent from 3 to 6 months and the rent roll indicated a net loss.
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The Department will follow up with a meeting.
Type A
10/14/2021
Section Cited

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Administrator Qualifications and Duties – The administrator shall have the qualifications specified…knowledge of and ability to conform to the
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applicable laws, rules, and regulations. Based on records reviewed of utility bill invoices during the solvency audit, the licensee had past due balances that resulted in a disconnection notice in December 2019 from Southern California Edison for the gas bill.
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The Department will follow up with a meeting.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MAGNOLIA PARK ASSISTED LIVING
FACILITY NUMBER: 547206604
VISIT DATE: 10/14/2021
NARRATIVE
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Continued from Page 1.

The purpose of the meeting was to discuss the solvency audit that was completed 6/16/2020 and the receivership order from 9/28/21 that was provided to the Department.

During the solvency audit discussion, licensee was informed that 1) the facility does not have a financial plan that assures sufficient resources to meet operating cost for care of resident of residents and 2) the licensee had past due balances that resulted in a disconnection notice in December 2019 from Southern California Edison for the gas bill.

It was discussed that per the receivership order, the licensee lost control of property. In effect, the license if forfeited. The Department requested a plan on what to do next by the COB today.

The Plan will include the following:
1.Statement that the licensee will not accept new residents
2. Provide residents and their responsible parties with a 60-day Notice
3. Assist in the relocation of residents, with resources of facilities nearby
4. Assist in COVID-19 testing to align with Department guidance and PINs

It was discussed that with the license forfeited, the relocation of residents is not temporary.

It was also discussed that the Department made it clear that as long as the licensee maintained control of property, the license would be valid. On 10/4/21, an office meeting was conducted with the licensee, in which, the Department was informed that an order for receivership was granted. During this meeting, licensee maintained she still had control of property. The court documents received did not support this false claim.

The licensee was informed that what action, if any, should the Department take is still under review. The Department will contact the licensee once the review is complete.



Deficiencies issued.
Exit interview conducted with Licensee, Administrator, & Attorney. Report Provided.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MAGNOLIA PARK ASSISTED LIVING
FACILITY NUMBER: 547206604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/15/2021
Section Cited

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False Claims -
It was also discussed that the Department made it clear that as long as the licensee maintained control of property, the license would be valid. On 10/4/21, an office meeting was conducted with the licensee, in which, the Department was informed that an order for receivership was granted. During this meeting, licensee maintained she still had control of property. The court documents received did not support this false claim.
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Based on interviews conducted with the licensee during the 10/4/21 office visit, licensee maintained that she still had control of property for the facility, this was not supported by the court order received by the Department.

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The Department will follow up with a meeting.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4