Facility Evaluation Report
Capacity6
Census4
Date signed10/03/2025 10:15:45 AM
Name of licensing program analystKelly Nguyen
Name of licensing program managerBennett Fong
On 10/03/2025 at 8:20 AM, Licensing Program Analysts (LPAs) K. Nguyen and P .Manalo and arrived unannounced to conduct case management to verify that Resident 1 (R1) who is bedridden has moved out of the facility.
During the visit, LPAs observation and interview revealed that Resident 1 (R1) has been moved out of the facility. Staff 1 (S1) stated that the resident moved to a different facility per conservator.
Exit interview conducted and a copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction