Facility Evaluation Report
On 10/14/2024 at approximately 2:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a Case Management - Annual Continuation inspection to complete the Required Annual Inspection that was partially completed on 10/3/2024. Upon entry, LPA stated the purpose of the visit to Caregiver Hershiell Leuterio and Caregiver Merwin Untalasco. Licensee Anna Manglicmot arrived at approximately 3:15 PM.
The LPA completed the inspection of facility records. The LPA reviewed the records of 5 residents and 5 staff members.
Administrator will provide LPA copies of the following documents by 10/21/2024:
1. LIC308 Designation of Facility Responsibility
3. LIC610E Emergency Disaster Plan (9 pages)
No citations issued during the inspection.
Exit interview conducted and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction