Facility Evaluation Report
Capacity6
Census3
Date signed08/25/2025 11:59:52 AM
Name of licensing program analystKelly Nguyen
Name of licensing program managerBennett Fong
On 8/25/2025 at 10:30 am, Licensing Program Analysts (LPAs) K. Nguyen and P. Manalo conducted an unannounced POC Case Management visit. LPAs met with care staff and Renato Tisico, explaining the purpose of the visit. LPAs spoke with Administrator (ADM) Victoria Puruganan via phone and received verbal permission for care staff to sign the report.
Upon reviewing R1 files, there are missing documents, including but not limited to:
A civil penalty on today's date is assessed for $300 due to failure to correct from 8/23/25 to 8/25/25.
An exit interview is conducted a copy of this report is provided with an appeal right.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction