Facility Evaluation Report

On December 17, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Licensee (LI) Allen Medina was notified via telephone and later arrived to assist with the inspection.

The Case Management inspection is being conducted to follow up on the annual inspection conducted on November 4, 2025. During the annual inspection, Licensees Allen Medina and Keak Vongphakdy agreed to submit the following to Community Care Licensing close of business day November 14, 2025:

Payroll records for all sixteen licensed facilities for August, September, and October 2025.

Utility bills for all sixteen licensed facilities for August, September, and October 2025.

Food receipts for all sixteen licensed facilities for August, September, and October 2025.

Rent payments for all sixteen licensed facilities for August, September, and October 2025.

However, Community Care Licensing did not receive the complete records for all sixteen licensed facility's by the due date as agreed upon. Additionally, the Licensees were granted an extension to submit the complete records by close of business December 10, 2025. However, Community Care Licensing once again did not receive the complete records for all sixteen licensed facility's. Community Care Licensing will be granting one final extension to submit the requested documents for all sixteen licensed facility's by close of business December 19, 2025. Community Care Licensing is also requesting the following to be submitted by the due date:

Updated LIC404 Financial Information Release and Verification forms for all sixteen licensed facility's.