Facility Evaluation Report
Capacity6
Census5
Date signed04/25/2024 03:04:49 PM
In conjunction to the complaint number 31-AS-20230406143049 Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted a case management- Deficiencies visit.
During the complaint investigation, it was confirmed that Licensee failed to submit a death report for Resident 1(R1) to CCL. LPAs conducted a file review and didn't observe death report on file.
Deficiencies Cited. Exit Interview Conducted. Report Issued
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction