Facility Evaluation Report
Capacity4
Census3
Date signed11/13/2025 09:11:12 AM
Name of licensing program analystCheyenne Ratajczak
Name of licensing program managerLaura Munoz
On 11/13/2025, Licensing Program Analysts (LPA) Cheyenne Ratajczak arrived unannounced to conduct a case management visit. LPA met with DSP Gloria Goldmas and explained the purpose of the visit.
On 10/29/2025 the facility sent an incident report into Community Care Licensing (CCL) concerning Resident #1 (R1). At this time R1 has not returned to the facility and facility has no return date for R1. LPA conducted interviews regarding R1. LPA requested for R1s LIC602 and IPP be emailed to LPA.
Exit interview conducted and a copy of the report was left at the facility.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction