Facility Evaluation Report
Capacity6
Census5
Date signed12/08/2021 03:00:30 PM
On 12/08/2021 at 2:00 pm, Licensing Program Analyst (LPA) T. White arrived unannounced to conduct a case management visit. LPA met with Administrator, Raksmey Roeum-Castleman . LPA explained the purpose of today’s visit. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 ambulatory clients. During the visit, LPA requested Personnel Report (LIC 500) and Client Roster (LIC 9020) for 2021 regarding a complaint investigation.
No deficiencies cited during inspection. Exit interview conducted with Administrator and a copy of report given.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction