Facility Evaluation Report
Capacity6
Census3
Date signed01/09/2026 10:47:49 AM
Name of licensing program analystBethany Mirlohi
Name of licensing program managerTroy Ordonez
Licensing Program Analyst (LPA) Bethany Mirlohi arrived to the facility to deliver complaint findings and conduct a case management visit.
LPA investigated complaint and found deficiencies unrelated to complaint allegations. While investigating complaint LPA found that facility did not report incident reports into CCL or to the residents responsible party. In addition, LPA found that resident files were incomplete and missing required documents.
Exit interview conducted and copy of report given.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction