Facility Evaluation Report
Capacity4
Census1
Date signed05/12/2026 01:53:01 PM
Name of licensing program analystJose Gary Tan
Name of licensing program managerTroy Agard
Licensing Program Analysts (LPAs) Jose Tan and Huma Rahimi conducted an unannounced initial complaint visit at this facility under complaint control no.: 31-AS-20260504153935, while conducting investigation, LPAs requested facility documents but the Administrator stated that there is no document 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