Facility Evaluation Report
Capacity6
Census2
Date signed10/20/2025 12:14:43 PM
Name of licensing program analystJames Sampair
Name of licensing program managerHarpreet Humpal
On 10/17/2025 at 11:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced for this Case Management - Health Checks visit. Upon entry into the facility, the LPA explained the purpose of the visit.
During the visit, the LPA observed the residents R1 and R2 in their bedrooms. The LPA was updated on the correct time and coverage for when the Licensee will go on vacation. The LPA obtained the total facility census.
Exit interview conducted and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction