Facility Evaluation Report
Capacity6
Census3
Date signed04/02/2025 02:50:30 PM
Name of licensing program analystRaquel Hernandez
Name of licensing program managerEfren Malagon
On 04/02/2025 Licensing Program Analyst (LPA) Raquel Hernandez conducted an announced visit to the facility in regards to Complaint 56-AS-20221031141433. Upon visit, LPA observed Administrator Sandy Zhao failed to report to the department death of former Resident #1 (R1) within 7 seven days of the occurrence.
Based on the observations made during today’s visit, a deficiency was cited per Title 22, Division 6, of the California Code of Regulations.
An exit interview was conducted, and this report (LIC809) (LIC809D) was discussed and provided Administrator Sandy Zhao. Along with a copy of the appeal rights.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction