Facility Evaluation Report

On February 04, 2026 at 2:20 PM, Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit. LPA Martinez met with Steve Bush and explained the purpose of the visit.

The purpose of today's visit is to discuss an Administrator change. LPA Martinez requested the following documents:

Letter from the Licensee requesting to appoint a new administrator to the facility.

Copy of current administrator certificate

Any documentation that meets the education and/or experience requirement

LIC 308 Designation of Facility Responsibility

LIC 200 signed by the Licensee or Designee. (update Administrator section)

Fingerprint and association documentation (Guardian Report)

Please email document to LPA Martinez by February 09, 2026, by 5:00 PM.