Facility Evaluation Report

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to the facility to conduct a case management visit on the health, safety, and welfare of residents in care. LPA met with the Caregiver, Nilda Agtang . LPA was informed that four (4) residents currently reside at this facility, with a capacity of four (4). There were two (2) staff on duty during the time of the visit.

LPA toured the facility and observed all facility utilities to be on and operating without issues. Food supply is sufficient. There is no immediate concern for residents in care.

No deficiencies are being cited and no civil penalties per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted with Caregiver, Nilda Agtang and a copy of this report is left with the her as evidence by her signature.