Facility Evaluation Report
Capacity5
Census4
Date signed06/15/2026 02:23:28 PM
Name of licensing program analystMelinda Medina
Name of licensing program managerSee Moua
On 6/15/2026, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management visit. LPA introduced self, stated purpose of visit and allowed entrance by Administrator, Vanessa Cruz.
LPA arrived to follow up on self reported incidents for Resident 1 (R1) that occurred on 5/11/2026, 5/12/2026, and 5/17/2026 where R1 left facility. During incidents that were reported, staff were present never losing supervision of resident.
LPA obtained copies of R1's physician's report and last IPP dated 6/2025.
There were no citations issued. An exit interview was conducted and a copy of this report was provided for facility records.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction