Facility Evaluation Report
On 12/17/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a required one year annual inspection. LPA met with Administrator Vlad Custura and explained the purpose of the visit.
LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: resident bedrooms, bathroom, laundry room, kitchen, backyard and common areas. In areas toured no immediate health, safety and personal rights violation observed.
LPA conducted a file review of facility fire drill record. LPA did not observe any drills being conducted for the year of 2025. LPA informed facility they are to conduct fire drills quarterly.
LPA conducted a file review of six (6) residents files. All files were incomplete with missing or incomplete documents. R1 and R2 are missing Physicians report (LIC602) and Needs& Service plan. R3 and R4 are missing admission agreements, ID page, Consent forms, Needs&Service and personal rights. R5 is missing their Needs&Service plan and personal rights. R6 documents are from their pervious facility and need to be switched to current facility. LPA conducted a file review of one (1) staff file. Staff file was missing Health screening and annual training.
As a result of today's visit deficiencies cited on LIC809D.
Exit interview conducted a copy of the report, appeal rights and LIC809G was left at the facility.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction