Facility Evaluation Report
Capacity6
Census3
Date signed03/05/2026 04:19:13 PM
Name of licensing program analystRamon Serrano
Name of licensing program managerRobyn Clark
Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management Visit. LPA was greeted by and met with Licensee Mary Ann Gutierrez, to discuss the purpose of the visit.
Today's visit is in response to the self reported death report involving Resident 1 (R1- see LIC811 Confidential Names List) who passed away on 12/25/25.
LPA interacted with staff and obtained facility records. No deficiencies were cited or observed on this date.
An exit interview was conducted with Mary Ann Gutierrez who was provided with a copy of this report and Appeal Rights. Their signature confirms receipt of these documents.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction