547209193-6-30-2023-24-AS-SMOA-CTML3L-20230711082407

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547209193
Report Date: 06/29/2023
Date Signed: 06/30/2023 03:54:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2023 and conducted by Evaluator Kelly J. McClurg

COMPLAINT CONTROL NUMBER: 24-AS-20230317132552

FACILITY NAME:	MAGNOLIA PARK ASSISTED LIVING		FACILITY NUMBER:	547209193
ADMINISTRATOR:	X,X		FACILITY TYPE:	740
ADDRESS:	2950 E. DOUGLAS AVE		TELEPHONE:	(559) 625-6001
CITY:	VISALIA	STATE: CA	ZIP CODE:	93292
CAPACITY:	59	CENSUS: 31	DATE:	06/29/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Executive Director (ED) Shelly Ramon; Resident Care Director (RCD) Sandra Guadarrama.		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Lack of supervision resulting in residents eloping from facility;

INVESTIGATION FINDINGS:

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An unannounced Complaint visit was conducted on the date & times indicated above by Licensing Program Manager (LPM) See Moua & Licensing Program Analyst (LPA) Kelly McClurg. LPM & LPA met with Executive Director (ED) Shelly Ramon & Resident Care Director (RCD) Sandra Guadarrama.

The Department conducted a tour of the facility, reviewed records, and conducted interviews. Based on interviews conducted and records reviewed, there was no incident of a resident eloping from the facility. The allegation is Unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurg	TELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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