Facility Evaluation Report
Capacity6
Census5
Date signed10/22/2025 12:48:03 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 Elena O'Connor, to discuss the purpose of the visit.
Today's visit is in response to the self reported incident of Client 1 (C1 - see LIC811 Confidential Names List) who passed away on October 16, 2025.
LPA interviewed facility staff and obtained facility records. No deficiencies were cited or observed on this date.
An exit interview was conducted with House Manager Adolfina Mendoza 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