Facility Evaluation Report
Capacity14
Census14
Date signed06/08/2026 12:09:02 PM
Name of licensing program analystJacques Leffall
Name of licensing program managerSee Moua
On 6/8/26, 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 6/2/226, in which R1 was not given on the dates of 5/30/26 and 5/31/26. LPA met with Administrator Jill Marmon.
Medication training was completed, and disciplinary actions taken against S1.
A citation and is being issued on the attached 809-D and regarding medications error.
A copy of this report with Appeal Rights were issued to Administrator whose signature confirms receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction