The Magnolia Tree Board and Care Home

Type of visit: Required - 1 Year

On today's date LPA William Vanegas conducted an unannounced visit for the purposes of completed an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by Administrator (AD) Marilou Yanson. LPA advised AD of the purpose of the inspection, and began a tour of the facility. LPA observed the following. The facility s a one storied home with five bedrooms two of which are staff rooms and three of witch are client rooms, three bathrooms one of which is a staff bathroom, and two of which are client bathrooms, and a two car detached garage. LPA observed for AD Marilou Yanson to have a valid Administrator Certificate that is set to expire on August 17, 2027. LPA observed all required postage to be posted at the entry way, and kitchen area of the facility. Including PUB 475, Ombudsmen sign, and resident rights. LPA Observed kitchen area to be clean and free of any mildew and debris. LPA observed there to be a gas stove, refrigerator, microwave, dishwasher, washer, and dryer. All were observed to be in good repair and tested operational. LPA observed there to be a two day supply of perishable food and a seven day supply of non-perishable food on hand. LPA observed a sufficient amount of emergency water and food on hand. LPA observed all resident rooms to be clean and in good repair. LPA observed resident rooms to have all required furnishings such as a bed, clean linens in good repair; meaning no strains or tares, a chest of drawers, a reading lamp, a chair, and enough storage space to store personal belongings. LPA observed no hazards in each resident room. CONTINUED ON LIC809-C LPA Observed all resident bathrooms to be clean and free of any mildew and debris. LPA observed resident bathrooms to have all required furnishings including a shower chair, slip resistant floor matts, and a shower chair. LPA observed toilets and faucets to be operational. LPA observed hot water temperature to be between 112.3 and 117.6 degrees. LPA observed all smoke detectors and carbon monoxide detectors to be in good repair and tested operational. LPA observed all fire extinguishers to be fully charged and up to date. LPA observed first aid kit to have all required items such as a thermometer, bandages, adhesive tape, scissors, tweezers, and a first aid manual. LPA observed outside of the facility to be clean and free of any hazards. No obstructions were observed to be outside or in the path of the emergency exits. There is a pool in the backyard, and it is fully fenced. The fence measures 5ft tall, and the gaps in between each bar is 4.5 inches. LPA observed side doors to be self latching and unlocked. LPA reviewed four resident files and three staff files. Resident files had all required documents. However staff records did not have updated annual training available for LPA review. A deficiency was issued on today's date. LPA reviewed medication administration record and medications. Per LPA review medications are being documented correctly and being administered per physicians orders. LPA reviewed P&I with AD and all balances were accurate and they were all documented correctly. Based on observations made during today's inspection deficiencies will be issued per tittle 22 division 6 of the California Code of Regulations. An exit interview was conducted with AD Marilou Yansen, and a copy of this report and appeal rights were provided to the facility. A copy of this report will be mailed to the facility as well.the state’s words, verbatim · CDSS document, Feb 6, 2026

Type of visit: POC

On February 5th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to complete a Plan Of Correction (POC) visit. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) and explained the purpose of the visit. LPA Vanegas began to review items of correction and observed the following all annual staff training has been completed and it has been filed in staff files. All staff files have been updated and all required documentation is in order. Water temperature was corrected and pool has been cleaned and appears to be in good repair. Based on observations made during today's visit no deficiencies have been cited an exit interview was completed and a copy of this report was left at the facility. .the state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: Case Management - Annual Continuation

On 01/15/2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to continue the annual inspection. Upon arrival LPA Vanegas was greeted and granted entry by Care Giver (CG) Marlenie Carazon. LPA Vanegas continued the annual inspection and observed the following. LPA Vanegas observed client bedrooms to be clean and have enough space to move freely in them. Client bedrooms had all the required furnishings such as a lamp, chest drawers, a bed with linens in good repair meaning no strains or tears and the required closet space. LPA Vanegas tested water temperature to be between 98.5-105 degrees. LPA Vanegas toured the outside of the facility and observed there to be an outdoor shaded seating area and a fenced pool. The fence measured to be 5 ft high. All exit routes are not obstructed by objects and is clear for an emergency evacuation. LPA Vanegas reviewed PNI with administrator (AD) Marilou Yanson and all balances were accurate and documented. LPA Vanegas reviewed resident medications and per LPA review medications are being administered per physicians orders. LPA Vanegas observed all required postings to be posted on visible walls of the facility however PUB 475 was not the correct size and a technical violation was issued on today's date. LPA Vanegas observed staff files to not have documented training and a deficiency was issued on today's date. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 15, 2025

The state marks this report as 3 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 01/09/2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted by Care Giver (CG) Marlenie Carazon and granted entry to the facility LPA Vanegas advised the purpose of the visit, and began to set up equipment. LPA Vanegas began a tour of the facility and observed the following. This is a one storied home with five bedrooms two of which are staff rooms and three of witch are client rooms, three bathrooms one of which is a staff bathroom, and two of which are client bathrooms, and a two car detached garage. LPA Vanegas observed the kitchen area to be clean and free of debris and mildew. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non-perishable food as well as a sufficient amount of emergency water on hand. LPA Vanegas observed a dish washer, microwave, gas stove, and refrigerator all were tested and operational and in good repair. LPA Vanegas observed client bathrooms and all were clean and free of debris and mildew. All bathrooms had required furnishings such as grab bars, slip resistant matts, and shower chairs. Water faucets and toilets tested to be operational and water temperature tested between 124.3 and 125.6 degrees. LPA Vanegas interviewed one staff member and one client. LPA Vanegas reviewed four client files and two out of four client files had all required documentation two client files were missing the required documents. LPA Vanegas reviewed three staff files and all staff files were missing training documentation and a health screening of staff member Marlenie was missing. LPA Vanegas advised that due to time constraints LPA would need to end the visit here and come back at a later time to continue the annual inspection. No deficiencies were issued at this time an exit interview was completed and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 9, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Plan of Correction (POC) inspection. LPA was greeted and granted entry by Staff Zenaida Aguinaldo. At 8:27 a.m. Administrator (AD) Marilou Sabio was contacted by phone and the purpose of the inspection was discussed. LPA is following up on deficiencies cited on 10/24/23, during facility’s annual inspection. Deficiency 1569.618(c)(3) was cited due to two out of two staff present not having current, unexpired CPR cards. During today’s inspection, LPA confirmed both staff present have CPR and first aid cards, with expiration dates of 10/26/25. Deficiency 87412(d) was cited due to AD not having a current, unexpired AD certificate and being unable to provide LPA with copies of documents submitted for certificate renewal. On today’s date, AD was also unable to provide LPA with a current, unexpired AD certificate and was unable to provide copies of documents submitted for certificate renewal; a Deficiency is being cited. One out of two deficiencies previously cited will be cleared. Based on today’s observations, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Dec 22, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(d) · Plan of correction due date: Jan 5, 2024

The licensee shall maintain documentation that an administrator has met the certification requirements... Administrator Certification Requirements or the recertification requirements... This requirement is not met as evidenced by: AD was unable to provide LPA with a current, unexpired AD certificate and was unable to provide copies of documents submitted for certificate renewal which poses a potential health, safety, and personal rights risk to person's in carethe state’s words, verbatim · CDSS document, Dec 22, 2023

Plan of correction: AD stated they will provide LPA with proof of documents submitted for AD certificate via email by POC date. AD stated they will ensure copies of documents submitted to CCL are available upon request.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Vera Manligas. LPA discussed the purpose of the inspection and Administrator (AD) Marilou Sabio was contacted by phone and arrived at 1:15 p.m. During the inspection LPA, Staff Manligas, and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with three resident bedrooms, three bathrooms, and two staff bedrooms. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The back yard has a shaded sitting area. LPA observed two staff and two residents present. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 120.3 F degrees. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Appliances were all inspected. Sharps were observed locked with medication. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents. Medication closet was observed to be locked. LPA reviewed two out of two resident files and three staff files. During staff file review, LPA observed staff present did not have a current, unexpired CPR and first aid card and AD does not have a current, unexpired AD certificate, and was unable to provide LPA with copies of documents submitted to CCL for AD certificate renewal; two Deficiencies were cited during today visit. LPA interviewed staff and residents present. Based on the observations made during today’s inspection, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Oct 24, 2023