Facility Evaluation Report
Capacity14
Census14
Date signed10/29/2025 11:25:00 AM
Name of licensing program analystJacques Leffall
Name of licensing program managerSee Moua
On 10/29/25, 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 10/17/25, in which R1 was administered the wrong medication. LPA met with Administrator (A1) Jill Marmon.
A citation is issued on the attached 809-D regarding medications not being administered correctly.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction