Magnolia Crossing

Type of visit: Required - 1 Year

On 02/05/2026, Licensing Program Analyst (LPA) Daiquiri Boyd arrived unannounced to conduct a required annual inspection. LPA was allowed entrance, announced purpose of the visit, and met with Administrator, Constance Peters. LPA toured the facility inside and out. LPA checked water temperatures in three resident’s bathrooms which read between 111 and 113.3 -degrees F. LPA observed two fire extinguishers in each home (Poppy, Iris and Sage) and were last serviced by Jorgenson on 03/19/2025. Three kitchens were toured, adequate supply of food observed, and food stored properly for perishable and nonperishable. Medication for Poppy and Iris homes are locked next to the kitchen area. In Iris home, medication room is in the back of the facility. Medication for Sage home is locked and located at the back end of the home. LPA toured bedrooms in each home and all were found to be properly furnished with adequate lighting, appropriate furniture and storage space. Smoke detectors and carbon monoxide were last inspected by the Fire Marshall on 6/17/2025 and found to be in working order. LPA completed record reviews for 6 staff and 6 resident files. All required documentation was updated and in place, meeting regulatory requirements. No deficiencies are being cited in accordance with the California Code of Regulations, Title 22, at today's inspection. The following updated forms are to be submitted to CCL by 02/16/2026: LIC 500, LIC 9282 Infection Control Plan. An exit interview was conducted with the Administrator. This report was discussed with Administrator, Constance Peters, whose signature appears on this form. A copy of this signed document was left at the facility.the state’s words, verbatim · CDSS document, Feb 5, 2026

Allegation investigated: Facility did not provide resident file as requested

Licensing Program Analyst (LPA) Daiquiri Boyd conducted the subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA spoke with staff and obtained and/or reviewed facility records and emails. It was determined based on interviews and records review that the above allegation is SUBSTANTIATED. Facility did not provide a copy of the resident file as requested to the resident and/or resident's responsible party within 2 days as stated. Based on LPAs observations and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Health and Safety Code 1569.269(a)(21) is being cited on the attached LIC 9099D. Substantiatedthe state’s words, verbatim · CDSS document, May 6, 2025 · control 24-AS-20250407133544

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(21) · Plan of correction due date: May 6, 2025

HSC 1569.269(a)(21) -To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies. This requirement was not met as evidenced by a request being made to obtain copies of the resident file was requested on 3/17/25 and copies were not provided until 4/12/25, beyond the allowed 2 days; which poses a potential risk to the health, safety, or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 6, 2025

Plan of correction: Administrator sent the requested documents to the attorney for the resident as requested. This deficiency is cleared.

Type of visit: Required - 1 Year

On 02/24/2025, Licensing Program Analysts (LPAs). R Bruce and D Boyd arrived unannounced to conduct a required annual inspection. LPAs were allowed entrance, announced purpose of the visit and met with Administrator, Constance Peters. LPAs toured the facility inside and out. LPAs checked water temperatures in three resident’s bathrooms which read between 107.6 and 114.5-degrees F. LPAs observed two fire extinguishers in each home (Poppy, Iris and Sage) and were last serviced by Jorgenson on 03/14/2024. Three kitchens were toured, adequate supply of food observed, and food stored properly for perishable and nonperishable. Medication for Poppy and Iris homes are locked next to the kitchen area in Iris home. Medication for Sage home is locked and located at the back end of the home. LPAs toured bedrooms in each home and all were found to be properly furnished with adequate lighting, appropriate furniture and storage space. Smoke detectors and carbon monoxide were last inspected by the Fire Marshall on 6/19/2024 and found to be in working order. LPAs completed record reviews for staff and resident files. Completed on the Annual Continutation form saved on the same date. All required documentation was updated and in place, meeting regulatory requirements. No deficiencies are being cited in accordance with the California Code of Regulations, Title 22, at today's inspection. The following updated forms are to be submitted to CCL by 03/15/2025: LIC308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9282, LIC999, and control of property. An exit interview was conducted with the Administrator. A copy of this report was discussed with Administrator, Constance Peters whose signature on this form confirms receipt of this documents.the state’s words, verbatim · CDSS document, Feb 24, 2025

Type of visit: Case Management - Annual Continuation

On 2/24/25, Licensing Program Analysts (LPAs) Daiquiri Boyd and Rachel Bruce made an unannounced visit to the facility to conduct an Annual Inspection and were met by Administrator (AD) Constance Peters. LPAs Boyd and Bruce toured the three facility buildings with AD. Documentation of the facility tour was done by LPA Bruce on separate LIC809 with the same date. This form has the file review for staff and clients attached.the state’s words, verbatim · CDSS document, Feb 24, 2025

Type of visit: Case Management - Other

On 12/5/2024, Licensing Program Analyst (LPA) Daiquiri Boyd made an unannounced visit to the facility for the purpose of conducting a check of the facility and records to verify that an employee is not employed or on the premises. Individual named Tiana Gilbert AKA Tiana Tiara Ros has not been employed at this facility since January 5, 2024. This individual was only employed at this facility for approximately two weeks in 2023. CDSS No.7924253001the state’s words, verbatim · CDSS document, Dec 5, 2024

Allegation investigated: Staff neglect resulted in a resident sustaining a fracture while in care Staff are mishandling the residents medications Staff are inappropriately administering the residents medications Staff did not properly report incidents involving the residents Staff are not being properly trained Staff did not provide adequate care and supervision to the residents Staff did not prevent the residents from engaging in an altercation Staff do not respond timely to the resident alerts Staff did not seek timely medical attention for a resident

On 10/18/24, Licensing Program Analyst (LPA) M. Medina conducted a subsequent unannounced complaint visit to conduct interviews and deliver findings. LPA introduced self, stated purpose of visit, and met with Administrator, Constance Peters. This department investigated the above allegations during the investigation, LPA toured facility, conducted interviews, and reviewed records. This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED. No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 18, 2024 · control 24-AS-20240529155053

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Daiquiri Boyd made an unannounced visit to the facility and met with Administrator Constance Peters. The purpose of this visit was to discuss an incident reported to Licensing on September 26, 2024. LPA Boyd arrived at the facility at 8:40 AM and staff advised LPA that they will call Administrator, staff advised that Administrator is on her way. The Incident Report provided to Licensing stated that a staff used inappropriate language when speaking to a resident in care. Additional information in the form of a copy of a letter that was sent to the employee, stating that they were releasing her and she was being terminated. LPA reviewed the terminated staff's file, which included the training records and a signed copy of the Resident Rights. Administrator told LPA that they had completed an investigation of the staff as soon as the allegation had come to their attention. Administrator stated that, although she was unable to determine if the events had occurred, she felt it was best policy to terminate the staff, as they do not condone this type of behavior. LPA interviewed staff mentioned in the Incident Report submitted to Licensing. In addition to speaking with Administrator, three staff were interviewed in person and one was called on the phone, and terminated staff was called as well; all during my visit. LPA conducted exit interview with Administrator. Citation issued on this day for personal rights violation.the state’s words, verbatim · CDSS document, Oct 1, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80072(a)(3) · Plan of correction due date: Oct 15, 2024

Personal Rights-80072 (a)(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coersion, threat, mental abuse, or other actions of a punitive nature...This requirement has not been met as evidenced by: Staff 1 speaking inappropriately to resident by calling resident a "fucking bitch", which poses a potential immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 1, 2024

Plan of correction: Licensee to conduct a "Personal Rights" re-training with all staff. This training is to be completed by October 15, 2024. Proof of re-training is to be emailed to Licensing. "Proof" is topic/subject matter discussed and a sign-in sheet of those in attendance.

Type of visit: Case Management - Health Checks

On 5/31/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management visit. LPA introduced self, stated purpose of visit and allowed entrance. LPA met with Administrator, Constance Peters and stated purpose of visit. Currently 46 residents in care. There are four residents on hospice, and six residents currently receiving home health services. Outside of facility toured. All exits open free of obstruction. No hazards observed No deficiencies observed or cited during visit.the state’s words, verbatim · CDSS document, May 31, 2024

Allegation investigated: Staff did not safeguard resident's personal belongings. Staff did not provide adequate food service to residents. Staff did not notify resident's authorized representative of a change in resident’s condition. Staff did not assist residents with bathing in a timely manner.

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to deliver findings on this investigation. LPA met with Facility Administrator, Constance Peters and announced the purpose of the visit. LPA conducted interviews, observations, and record reviews. Regarding staff did not safeguard resident's personal belongings. LPA conducted interviews, record review and LIC621 form. There was no supportive documentation found on file to support that resident's belongings were not safeguard. Regarding staff did not provide adequate food service to residents. Based on conducted observations, file reviews, and interviews this allegation was found unsubstantiated. Continue 9099-C Unsubstantiated Regarding staff did not notify resident's authorized representative of a change in resident's condition. Based on record review, review of the LIC602A form, and interviews there was not enough evidence on file to support that staff did not notify resident's authorized representative of a change in resident's condition. Staff did not assist residents with bathing in a timely manner. Based on conducted observations and interviews, there was no evidence found that staff are not assisting residents with bathing in a timely manner. The Department has investigated the above allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No Deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Facility Administrator, Constance Peters. A copy of this report was provided to the Administrator, along with the appeals rights.the state’s words, verbatim · CDSS document, Feb 27, 2024 · control 24-AS-20240126102342

Type of visit: Case Management - Annual Continuation

This Licensing Program Analyst (LPA) M. Flores arrived unannounced to continue an annual inspection. LPA was allowed entry by Administrator, Constance Peters. LPA completed record reviews for staff and resident files. Deficiency are being cited in accordance with the California Code of Regulations, Title 22, see LIC809D. The following updated forms are to be submitted to CCL by 02/27/24: LIC308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9282, LIC999, and control of property. An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed Administrator, Constance Peters whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Feb 21, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 02/20/2024, Licensing Program Analyst (LPA) M. Flores arrived unannounced to conduct a required annual inspection. LPA met with Administrator, Constance Peters and announced the purpose of the visit. LPA toured the facility inside and out. LPA checked water temperatures in six resident’s bathrooms which read between 112.6- and 119.6-degrees F. LPA observed two fire extinguishers in each home (Poppy, Iris and Sage) and were last service on 04/13/2023. Three kitchens were toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication for Poppy and Iris homes are locked next to the kitchen area in Iris home. Medication for Sage home is locked and located at the back end of the home. LPA observed six bedrooms which were properly furnished, had adequate lighting, and storage space. Smoke detectors and carbon monoxide were last inspected by the Fire Marshall on 2/16/24. Due to time constraints annual inspection was not completed at this time. No deficiencies and citations were issued at this time. LPA will return to the facility on another date to complete this annual inspection. Exit interview was conducted with Administrator, Constance Peters.the state’s words, verbatim · CDSS document, Feb 20, 2024

Allegation investigated: Staff handle resident in a rough manner Staff emotionally abuses resident Staff do not assist resident with ambulating Staff do not assist resident with personal care Staff do not assist resident with incontinence needs Staff spoke inappropriately to resident

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to deliver findings on this investigation. LPA met with Facility Administrator, Constance Peters and announced the purpose of the visit. LPA conducted interviews, observations, and record reviews. Regarding staff handling residents in a rough manner, LPA interview four residents. Three of the four residents reported they have not seen or heard staff handle residents in a rough manner. One resident reported hearing from other residents that residents are handled in a rough manner. Continue 9099-C Unsubstantiated Regarding staff emotionally abusing residents, LPA interviewed four resident assistants who all denied hearing or witnessing staff emotionally abusing residents. Four of the residents also denied hearing or witnessing emotional abuse from staff. Regarding staff not assisting resident with ambulating. Interviews conducted with staff, staff reported that they did not witness or heard staff denying assistance to residents with ambulating. Half of the residents reported that they have not heard or witnessed staff not assisting residents with ambulating. The other half of the residents interviewed; it was reported that they have only heard from other residents that some staff do not assist residents with ambulating timely. Regarding staff not assisting residents with personal care, LPA conducted eight interviews between residents and resident assistants. All parties interviewed denied hearing or witnessing staff not assisting residents with their personal care. Regarding staff not assisting resident with incontinence needs, LPA conducted eight interviews between residents and resident assistants; All parties interviewed denied hearing or witnessing staff not assisting residents with incontinence needs. Regarding to staff speaking inappropriately to residents, LPA conducted eight interviews between residents and resident assistants. All parties interviewed denied hearing or witnessing staff speaking inappropriate to residents. It was shared by one of the residents that they witnessed a resident speak inappropriate to staff. The Department has investigated the above allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No Deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Facility Administrator, Constance Peters. A copy of this report was provided to the Administrator, along with the appeals rights.the state’s words, verbatim · CDSS document, Feb 6, 2024 · control 24-AS-20231201155005

Allegation investigated: Staff do not administer resident's medications as prescribed Staff do not assist resident in receiving physical therapy as needed Staff do not assist resident with mobility needs

On 12/08/2023, Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to deliver findings on the allegations listed above. LPA met with Facility Administrator Constance Peters to discuss the elements of the allegations. Regarding the allegation, staff do not administer resident’s medication as prescribed. Based on interviews and record reviews, it is unclear weather or not R1’s medication was not administered as prescribed. LIC602A physician’s report state R1 can leave the facility unsupervised and able to administer own prescription medication. R1 has prescribed medication that facility cannot administer without physician’s orders. Continue page 2 - 9099C Unsubstantiated Regarding the allegation, staff do not assist resident in receiving physical therapy as needed. Based on interviews and record review, it is unclear weather or not staff assisted resident in receiving physical therapy as needed. R1 was discharged from physical therapy on 8/29/23 and reassessed for physical therapy on 10/25/23. Regarding the allegation, staff do not assist resident with mobility needs. Based on interviews and record review, it is unclear weather or not staff do not assist resident with mobility needs. Physician’s orders for electric mobility device was fill; electric mobility device is pending delivery. The Department has investigated the above allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No Deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Administrator, Constance Peters. A copy of this report along with appeals rights provided.the state’s words, verbatim · CDSS document, Dec 8, 2023 · control 24-AS-20231013160821