Facility Evaluation Report
Capacity6
Census4
Date signed05/26/2026 05:07:30 PM
Name of licensing program analystEdward Kim
Name of licensing program managerLourdes Montoya
On May 26, 2026, ,Licensing Program Analyst (LPA) Edward Kim conducted a case management- deficiency visit unrelated to a complaint investigation (Complaint# 22-AS-20250305152012).
LPA observed the facility did not send an incident report with R1 wandering away from the facility and going to the hospital on March 4, 2025.
A deficiency was cited during the inspection visit according the California Code of Regulations Title 22 Division 6 Chapter 8. Facility
An exit interview was conducted, and a copy of this report and the appeal rights were provided to Administrator Jenny Pham.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction