Facility Evaluation Report
Capacity6
Census6
Date signed06/04/2025 03:11:41 PM
Name of licensing program analystJacques Leffall
Name of licensing program managerSee Moua
On 6/4/25, Licensing Program Analyst (LPA) J. Leffall conducted a case management visit to follow up and confirm details of an incident report that was received by the Department. The incident occurred on 5/29/25, in which R1 eloped from facility. LPA met with Administrator Shannon Steele.
A1 reported to LPA that battery on the auditory device was low in power and staff was not able to hear door open when Resident left the facility.
A citation and is being issued on the attached 809-D regarding the auditory device at the facility.
A copy of this report was issued to A1 whose signature on this form confirms receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction