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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209193
Report Date: 07/11/2023
Date Signed: 07/11/2023 07:47:25 PM


Document Has Been Signed on 07/11/2023 07:47 PM - It Cannot Be Edited

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:
547209193
ADMINISTRATOR:RAMOS, MESHELLFACILITY TYPE:
740
ADDRESS:2950 E. DOUGLAS AVETELEPHONE:
(559) 625-6001
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:59CENSUS: 31DATE:
07/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Executive Director (ED) Shelly Ramos;TIME COMPLETED:
08:00 PM
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An Case Management visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) Kelly McClurg. LPA met with Executive Director (ED) Shelly Ramos.

During this visit multiple topics were reviewed & discussed including:
  • Maintenance of Client records, including Admission Agreements,
  • Documentation & record keeping, including medications;
  • Use of appropriate Licensing forms;
  • Conducting & documenting Pre-Admission Appraisals;
  • Medication audits;
  • Observation of the Resident & documentation when resident returns to facility, i.e., hospital, etc.
  • How to access public records on CCLD website;

In addition to many other subjects.

Exit interview conducted with ED. Copy of report provided @ time of visit.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023
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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