Facility Evaluation Report
Capacity6
Census5
Date signed08/07/2025 09:01:09 AM
Name of licensing program analystChihhsien Chang
Name of licensing program managerRomeo Manzano
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management - incident visit and met with Administrator (ADM) Ini Uboh.
On 7/31/2025, the Department received a report regarding resident R1's incident and death.
LPA interviewed Administrator (ADM) Ini Uboh, 2 staff (S1, S2).
LPA requested resident's physician report, appraisal needs and service plan, and Individual Program Plan (IPP).
Exit interview was conducted with ADM. The report was provided to ADM for review and signature. A copy of the report was provided to ADM.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction