Facility Evaluation Report

On 10/23/2025 at 2:00 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with Licensee, Josefina Gardner,and explained the purpose of the visit. Josefina gave authorization for Caregiver, Sinforosa Arawiran, to sign the report.

While LPA was conducting a complaint investigation # 15-AS-20240202150258 on 10/23/2025, LPA observed during record review that S3 was not associated to the facility in Guardian.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided