Facility Evaluation Report
Capacity6
Census6
Date signed04/14/2025 12:04:36 PM
Name of licensing program analystJose Gary Tan
Name of licensing program managerTroy Agard
Licensing Program Analyst (LPA) conducted an unannounced case management visit at this facility to issue a deficiency in conjunction with the complaint investigation on complaint dated 02/11/25 with complaint control number 31-AS-20250205121127. During the course of the investigation LPA found a deficiency on the conduct of Staff #1 towards Resident #1 (R1), wherein S1 planned or intended to borrow money from R1.
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