Facility Evaluation Report
Capacity6
Census5
Date signed05/05/2025 02:32:03 PM
Name of licensing program analystTuesday Cabiness
Name of licensing program managerTroy Agard
Licensing Program Analyst (LPA) Tuesday Cabiness, conducted a case management in regards to additional documentation that is needed for resident # 1 (R1).
Also during the visit, LPA observed the Administrator/Licensee's administrator certificate expired 01/16/2025. LPA was informed that Allen, the son of the Administrator would be taking responsibility and becoming the Administrator for the facility. LPA sent a list of documents and information that is needed in order to make the changes. A citation will be issued for an expired Administrator's certificate.
Exit interview, citation, appeal rights, and copy of report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction