Facility Evaluation Report
Capacity6
Census4
Date signed09/03/2024 02:16:24 PM
On 09/03/24, Licensing Program Analyst (LPA) Gina Saucedo, conducted unannounced, subsequent visit to this facility in conjunction with a complaint control #31-AS-20240214144751. LPA met with the Caregiver, Oleh Markiv and explained the reason for the visit.
During the physical tour, LPA conducted a review of records and no incident report was sent to Community Care Licensing Department-(CCLD) for any of the residents.
Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D.
Exit interview conducted, appeal rights and copy of report signed and delivered to the Caregiver.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction