Facility Evaluation Report
Capacity4
Census3
Date signed08/14/2025 12:08:21 PM
Name of licensing program analystCheyenne Ratajczak
Name of licensing program managerLaura Munoz
On 08/14/2025, 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 08/12/2025.Resident #1 (R1) had an immediate move out from the facility. LPA conducted interview concerning incident with facility Administrator.
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