Facility Evaluation Report
On 06/22/2026 at 12:00pm, the Department conducted an unannounced case management deficiencies at the facility listed above. Licensing Program Analyst (LPA) Zina Brown met with Myrna Ma (Licensee) and explained the purpose of the visit.
During the complaint investigation for 11-AS-20250910151908 , the Department observed the following:
On 09/15/2026, upon the Department conducting the initial complaint investigation visit, LPA observed and obtained incomplete documentation that was not filled out such LIC 603 Preplacement Appraisal, LIC 625 Appraisal/ Needs and Service Plans and Home Health Care Plan for Resident 1 (R1).
On 06/22/2026, during the subsequent complaint investigation visit for 11-AS-20250910151908, the Department observed 1 employee such as Staff 1 (S1) not being associated to the facility at the time of unannounced complaint investigation.
As a result, civil penalties are being assessed and a deficiency is being cited for 87355(e)(2) Criminal Record Clearance under California Code of Regulation Title 22, Division 6, Chapter 8 are being cited on the LIC 809-D.
Exit interview conducted with Myrna Ma (Licensee) and a copy of this report was provided with appeal rights
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction