Facility Evaluation Report

At 2:00 PM on 9/30/2025, Licensing Program Analyst (LPA) James Sampair arrived unannounced for this Case Management visit regarding the change of ownership and change of administrator notification received from Licensee / Administrator (ADM) Mary Asilum on 9/23/2025. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Caregiver Julie Dual.

The LPA interviewed Staff S1 and Staff S2 in person and Staff S3 and Staff S4 by telephone about the change in ownership and the change in ADM. Before arriving at the facility, the LPA discovered that S4, whom the ADM had stated was taking over ADM duties, had an expired ADM certificate. While at the facility, the LPA discovered that S3, who had been acting as ADM, had no ADM certificate at all.

During the inspection, the LPA discovered from record reviews that S3 was not associated with the facility and S1 was not fingerprint cleared.

2 Type-A and 1 Type-B citations were issued during this inspection (for details refer to LIC 809-D).

Deficiencies are cited from Title 22 California Code of Regulations (refer to LIC 809-D). Failure to submit proof of correction may result in additional civil penalty.

Exit interview conducted and a copy of the Appeal Rights, and this report provided.