Facility Evaluation Report
Capacity148
Census109
Date signed05/28/2025 06:02:57 PM
Name of licensing program analystJacques Leffall
Name of licensing program managerSee Moua
On 5/28/25, 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 5/10/25, in which R1’s medication was not given but signed off. LPA met with General Manager Michelle Ramos.
Medication training completed on 5/13/25 and staff and completion sheet submitted to CCLD on 5/22/25.
A citation and civil penalty is being issued on the attached 809-D and 421FC regarding medications error.
A copy of this report with appeal rights was submitted to General whose signature confirms receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction