<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209350
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:16:30 PM

Document Has Been Signed on 12/07/2023 03:16 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:
12/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:House Manager, Florencia TopeteTIME COMPLETED:
12:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst conducted a case management visit in response to a visit conducted by the Department on 10/24/2023. LPA Williams met with House Manager, Florencia Topete and discussed the purpose of the visit.

On 10/24/2023 Staff 1 and the Administrator reported no training had been completed regarding assisting residents with mobility and transfers.

The Administrator reported training would be conducted regarding mobility and transfer of residents.

Based on the Departments interviews a deficiency is being cited on the attached LIC 9099D page.

A plan of correction was reviewed and discussed.

An exit interview was conducted and a copy of this report and appeal rights will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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 2
Document Has Been Signed on 12/07/2023 03:16 PM - It Cannot Be Edited


Created By: Darius Williams On 12/07/2023 at 11:41 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: MAGNOLIA SPRINGS-SADDLEBACK
FACILITY NUMBER: 157209350

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/29/2023
Section Cited
CCR
87411(d)(3)

1
2
3
4
5
6
7
(d)All personnel shall be given on the job training or have related experience in the job assigned to them....(3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents.
This requirement was not met evident by:
1
2
3
4
5
6
7
House Manager reported she will contact a Licensed Professional to conduct training for assisting residents with mobility and transfers. A copy of the training sign in sheet and topics covered will be provided to the Department by POC due date, 12/29/2023.
8
9
10
11
12
13
14
The Licensee did not ensure staff had training with mobility trasnfer of resident, which poses a potential health and safety risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Serigy Pidgirny
LICENSING EVALUATOR NAME:Darius Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2