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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209350
Report Date: 06/15/2023
Date Signed: 06/15/2023 02:56:08 PM

Document Has Been Signed on 06/15/2023 02:56 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 SPRINGS-SADDLEBACKFACILITY NUMBER:
157209350
ADMINISTRATOR:HOUCK, HELENFACILITY TYPE:
740
ADDRESS:7312 SADDLEBACK DRIVETELEPHONE:
(661) 664-7758
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
06/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Administrator, Helen HouckTIME COMPLETED:
10:35 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an announced Pre-licensing visit regarding change of ownership with clients in care. LPA Williams met with Administrator, Helen Houck and discussed the purpose of the visit.

The tour began at the front entrance. Facility temperature reflected approximately 76.4 degrees Fahrenheit (F). The living room and dining room were clean, in good repair, and had seating for all clients.

Kitchen was clean and in good repair. Two weeks of perishable food and two days of non-perishable food was available.

LPA toured four bedrooms. All bedrooms had a bed (required linen), chair, dresser, working lights, and free of odor. Extra linens were available as needed.

Two bathrooms were toured. Bathrooms were clean, in good repair, and free of odor. Grab bars and non slip mats were available. Bathroom sink water temperature reflected approximately 106.8 degrees F.

First Aid, smoke detector, carbon monoxide, and fire extinguisher were present and operational.

Chemicals and medications were observed locked and inaccessible to clients.

LPA reviewed 1 staff file and 1 client file. Both files had documents requested by the LPA.

No License has been issued at this time. LPA will forward report to Central Applications Bureau for further review. Component III was reviewed with the Administrator.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2023
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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