Facility Evaluation Report
Capacity6
Census4
Date signed11/13/2025 04:15:11 PM
Name of licensing program analystLuisa Fontanilla
Name of licensing program managerYvonne Flores-Larios
At around 2:55 pm, LPA Luisa Fontanilla arrived unannounced to conduct a case management visit. LPA explained to Domanillo the purpose of the visit.
The purpose of the visit is to issue deficiencies and civil penalty in connection with the visit done on July 30, 2025 when Client 1 (C1) was diagnosed with one stage 1 pressure injury in the buttock and three (3) unstageable pressure injuries.
Deficiency is cited per Title 22 California Code of Regulations. Civil penalty of $500 is assessed during the visit.
Exit interview was conducted with Dominillo and Appeal Rights was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction