Facility Evaluation Report
Capacity5
Census3
Date signed07/17/2025 09:34:43 AM
Name of licensing program analystShannan Hansen
Name of licensing program managerBethany Moellers
At 8:15am Licensing Program Analyst (LPA) Hansen arrived unannounced at facility for the purpose of conducting a Case Management regarding a self-reported incident report from facility received on 7/15/2025 informing department Cleint (C1) sustained injuries as a result of going off the back porch, 2 nd story balcony, which was an unwitnessed fall.
LPA observed 3 clients (C2, C3, & C4) with only 1 staff (S1) at facility during the visit. Staff contacted Administrator who authorized S1 to sign for today's visit. LPA spoke with Administrator.
LPA conducted interview for update of R1 & made observations.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction