Facility Evaluation Report
Capacity6
Census3
Date signed12/08/2025 11:09:08 AM
Name of licensing program analystJacques Leffall
Name of licensing program managerSee Moua
On 12/8/25 at 11:00am Licensing Program Analyst (LPA) J. Leffall arrived at the facility and was greeted by Licensee (L1) Roxanna Escalante. LPA was granted entry. The purpose of the visit is to conduct a Health and Safety check on behalf of R1.
LPA toured facility and conducted a Health and Safety check. LPA requested R1’s file to include Admission Agreement, Physician’s Report, Medical Assessments, and charts.
At this time, this requires additional follow-up.
Copies of R1’s file was obtained for review.
A copy of this form was submitted to Licensee whose signature confirms the receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction