Facility Evaluation Report

Licensing Program Analyst (LPA) Cassandra Mikkelson and Licensing Program Manager (LPM) Laura Munoz arrived at facility to conduct an unannounced case management visit due to the Licensee's failure to pay licensing fees. LPA met with Administrator Adi Lina Tuiloma and explained the purpose of the visit.

This facility has an outstanding balance for annual fees due. The current amount owed is $742.00 and was billed on 09/03/2025. As of this date, the fees are overdue. LPA explained to Licensee that proof of payment and/or proof of payment plan needs to be provided to CCL 03/19/2026.

Per California Code of Regulations, Title 22, Type B deficiency is being cited today in violation of California Code of Regulations and follows on 809-D.

Exit interview held with Caregiver and a copy of report provided.