Routine inspection·October 17, 2025

At approximately 8:30 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Administrator Elizabeth Matos. Magnolia Manor is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for five (5) non-ambulatory residents, two (2) of whom may be bedridden. The facility has a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were four (4) residents in care and two (2) staff member on-site. At approximately 9:00 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:15 AM, LPA toured the facility with Administrator Matos. All exits were clear and unobstructed. All three (3) fire extinguishers were last serviced and tagged on 9/9/2025. The facility was sufficiently lighted. LPA inspected four (4) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 10:00 AM, LPA reviewed four (4) resident files. One (1) of four (4) resident files (for resident R1) was observed to not have signed Personal Rights Documents. This Deficiency will be cited. All other resident files were observed with all required documentation. LPA reviewed four (4) staff files. Two (2) of four (4) staff files (for staff members S1 and S2) were observed to be missing current First Aid and CPR certification. This deficiency will be cited. All other staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Elizabeth Matos’s Administrator Certification 7007055740 is current with an expiration date of 11/11/2026. LPA requested the following documents be submitted to Community Care Licensing by 11/17/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCR), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Matos. Signature on form confirms receipt of documents.