Facility Evaluation Report
Capacity4
Census4
Date signed06/19/2025 10:41:35 AM
Name of licensing program analystCheyenne Ratajczak
Name of licensing program managerLaura Munoz
On 06/19/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived unannounced to conduct a case management visit. LPA met with Administrator Thelma Mamaril and explained the purpose of the visit.
Facility sent an incident report into Community Care Licensing (CCL) concerning an incident that occurred on 06/12/2025. LPA conducted interviews concerning incident and requested for Resident #1 (R1s) Physician's Report (LIC602) and Needs and Service Plan.
Exit interview conducted and a copy of the report and LIC809G was left at the facility
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction