Facility Evaluation Report
Capacity6
Census6
Date signed04/22/2025 02:44:40 PM
Name of licensing program analystDaniel Konishi
Name of licensing program managerDavid Sicairos
Licensing Program Analyst (LPA) Daniel Konishi conducted a complaint visit at 8:45am. During the course of the investigation related to Complaint Control Number:28-AS-20250416132743, based on interview and record review, the facility staff did not follow proper CPI procedures for a client in care.
Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit are documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided to Staff #4 (S4).
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction