Facility Evaluation Report
Capacity6
Census2
Date signed07/30/2025 03:41:18 PM
Name of licensing program analystKelly Nguyen
Name of licensing program managerBennett Fong
On 7/30/2025 at 10 am, Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced Case Management visit to review residents’ (R) files. LPA informed Administrator, Victoria Puruganan, of the purpose of the visit. Victoria Puruganan arrived approximately 1 hour later.
LPA obtained R1, R2, and R3 physician reports, identification, and emergency information.
LPA obtained facility liability documentation.
There is no deficiency during this visit.
Exit interview conducted and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction