Facility Evaluation Report
Capacity15
Census10
Date signed05/13/2025 02:53:03 PM
Name of licensing program analystDavid Doidge
Name of licensing program managerBennett Fong
On this day while at the facility conducting investigation in connection with complaint 15-AS-20250324113724, LPAs observed the following:
R1 did not have completed preplacement and Appraisal Needs and Services Plan
R2 eloped from the facility on January 14, 2025 and ended up at Kaiser Hospital for pneumonia and hypothermia
the facility did not report incident to CCL
Deficiencies are cited per Title 22 California Code of Regulations (refer to Lic 809D).
Exit interview was conducted with Pascual and Appeal Rights was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction