Facility Evaluation Report
Capacity6
Census0
Date signed04/06/2026 04:08:19 PM
Name of licensing program analystMelinda Medina
Name of licensing program managerSergiy Pidgirny
On 4/06/2026, Licensing Program Analyst (LPA) M. Medina conducted an announced Case Management visit requested by Licensee.
Facility was licensed for a change of location on 4/01/2026. LPA was notified by licensee that residents would be transferred the weekend of 4/03/26.
LPA conducted a walk through of facility and observed all belongings to be removed from all common areas of facility and resident bedrooms.
License was provided to LPA facility license and signed by licensee as "Closed, residents transferred"
A copy of signed report will be provided via e-mail to licensee for facility records.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction