Facility Evaluation Report
Capacity6
Census5
Date signed07/11/2025 04:05:35 PM
Name of licensing program analystMai Yang
Name of licensing program managerSee Moua
On 07/11/25, Licensing Program Analyst (LPA) M. Yang arrived to conduct an unannounced subsequent
complaint investigation and met with Assistant Administrator Lisa Pua.
During the course of the investigation visit, LPA toured the facility and reviewed residents’ records. The department observed R1 with no bed.
Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,
Division 6. An exit interview was conducted. A copy of this report and appeal rights was provided to Assistant Administrator, whose signature on this form confirms receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction