Facility Evaluation Report
Capacity6
Census5
Date signed05/20/2025 02:01:14 PM
Name of licensing program analystMai Yang
Name of licensing program managerSee Moua
On 05/20/25, Licensing Program Analyst (LPA) M. Yang arrived to conduct an annual inspection. LPA met House Manager (HM)/ designated representative Heidi Snavely.
During the inspection, LPA reviewed R1’s file and conducted interviews. R1 had went to the hospital on three occasions and was provided an eviction letter on 05/12/25.
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 was provided to House Manager, whose
signature on this form confirms receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction