Facility Evaluation Report
Capacity10
Census10
Date signed03/26/2025 05:01:32 PM
Name of licensing program analystMurial Han
Name of licensing program managerApril Cowan
On March 26, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced continuation visit for an annual inspection that was conducted March 18, 2025. LPA met with the administrator and explained the purpose of today's visit.
LPA reviewed 7 resident files, and conducted facility tour that was provided by the administrator.
Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties.
This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction