Facility Evaluation Report

Licensing Program Analyst (LPA) Cassandra Mikkelson conducted an unannounced case management visit on December 30,2025. This visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES.

LPA met with Care staff Zioa Ribero and stated the purpose of visit. Facility understands this is an Immediate Exclusion effective December 30, 2025 and Staff Member S1 is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility.

Exit interview conducted, a copy of this report provided on this date. A signature on these forms acknowledges receipt of these forms.