Facility Evaluation Report
Capacity15
Census12
Date signed07/19/2023 03:26:49 PM
On 7/19/23 at approximately 9am Licensing Program Analyst (LPA) Maja Jensen and a department auditor arrived at facility for a scheduled visit to continue collecting data for a trust audit. LPA Jensen and the Department auditor met with Licensee Justice Ehimamiegho and Stephanie Siewe and explained the purpose of today's visit.
During the course of the visit the department auditor interviewed 7 of 12 residents. In addition the auditor scanned copies of the LIC 602 and admission agreement for residents 1 through 7 (R1-R7).
An exit interview was conducted and a copy of this report was handed to Stephanie Siewe.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction