Facility Evaluation Report
Capacity6
Date signed05/21/2026 04:09:00 PM
Name of licensing program analystSimranjit Rai
Name of licensing program managerRomeo Manzano
Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to follow up on the Death Repot for resident R1 who was not on Hospice services. LPA Rai met with Care Staff, Ladan Said and stated the purpose of the visit.
During today's visit, LPA Rai received the following copies to include but not limited to R1's Appraisal/Needs and Services Plan, Physician's Report and Death Report.
At this time, this case in under review and Department will conduct a follow up visit, if warranted.
This report was reviewed with Care Staff, Ladan Said and a copy of the report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction