Facility Evaluation Report
Capacity4
Census1
Date signed05/12/2026 03:03:17 PM
Name of licensing program analystHuma Rahimi
Name of licensing program managerNichelle Gillyard
Licensing Program Analysts (LPAs) Huma Rahimi and Jose Tan conducted an unannounced initial complaint visit at this facility under complaint control no.: 31-AS-20260504170801, while conducting investigation, LPAs requested facility documents but the Administrator stated that there are no documents available at the facility for the resident and/or staff.
Citation issued. Appeal rights discussed and given.
Exit interview conducted. Copy of this report issued.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction