Facility Evaluation Report
Capacity6
Census6
Date signed05/07/2025 12:43:56 PM
Name of licensing program analystEdward Kim
Name of licensing program managerLourdes Montoya
On May 7, 2025, Licensing Program Analyst (LPA) Edward Kim conducted a case management deficiency visit unrelated to a complaint investigation (Complaint# 22-AS-20250506140457).
LPA observed the following deficiency: S1 was working from May 1, 2025 to May 7, 2025, without association to the facility.
A deficiency was cited during the inspection visit according the California Code of Regulations Title 22 Division 6 Chapter 8. A civil penalty was assessed at this visit.
An exit interview was conducted, and a copy of this report, LIC811, and the appeal rights were provided to Administrator Saleem Moosani.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction