Senior Care Records.

Facility Evaluation Report

Illinois Home, LLC, Fair Oaks10/28/2025Licence 345920017

Capacity4
Census3
Date signed10/28/2025 01:42:55 PM
Name of licensing program analystMichael Hood
Name of licensing program managerAnthony Perez
The inspector’s account

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrators, Dexter Samson and Jasmin Samson, to conduct an unannounced case management visit on October 28, 2025. The visit is to confirm Decision and Order for staff member (S1).

During visit, LPA reviewed Decision and Order with Administrators. Administrators stated that S1 was never employed at the facility and was only a prospective applicant. LPA confirmed that S1 was not associated to facility as of October 28, 2025.

No deficiencies are being cited as a result of today's visit. Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these forms.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction