Facility Evaluation Report

Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management Visit. LPA identified herself and met with Licensee/Administrator David Larson, and discussed the purpose of the visit.

Today's visit is in response a file review conducted by the Department. The Licensee for this facility is Habilitative Homes Residential Care Facility LLC. Per review of the California Secretary of State website, their status shows as "Suspended - FTB."

Larson stated that he was changing tax designation status and there was some confusion about LLC. However, Licensee is willing to bring the LLC status to current.

As of today, 11/22/2022, the California Secretary of State website still shows the LLC's status as "Suspended - FTB," and the Statement of Information was due on 10/31/2022. This deficiency is cited in accordance to the California Code of Regulations, Title 22, Division 6, Chapter 1, and is noted on the attached LIC809-D. No other health or safety issues were observed on this date.

The Licensee was provided a copy of their Appeal Rights (LIC9058 3/22), and their signature on this form, acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided to Licensee/Administrator David Larson.