Facility Evaluation Report

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an case management visit due to a request to change the facility capacity. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Licensee Yvonne Samora.

A Change of Capacity application was received by the Department on March 12, 2024, in which the licensee requested an increase in ambulatory capacity from 4 to 6 residents. The Fire Safety Inspection Request was approved by the local fire authority on April 10, 2024.

During today’s visit, LPA toured the facility and inspected each room. The facility sketch was consistent with the current layout of the facility. No immediate health and/or safety concerns were observed during today's visit.

The completed change of capacity request will be forwarded to management for final review and approval. An exit interview was conducted with Licensee, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).