Senior Care Records.

Facility Evaluation Report

Lsa - Home #3, Santa Clara01/29/2025Licence 435201682

Capacity6
Census4
Date signed01/29/2025 11:52:17 AM
The inspector’s account

On January 29, 2025 at 11:48 AM, Licensing Program Analysts (LPAs) Kenneth Madrigal and Simi Rai arrived at the facility unannounced to conduct a case management – other visit. LPAs met with Justin Williams, Staff Training & Development Coordinator. LPAs observed zero residents and zero staff.

The purpose of the visit is to hand deliver an immediate exclusion letter for an individual (S1) who the Department determined engaged in conduct inimical as a staff in the facility. The letter was handed to the Staff Training & Development Coordinator. The Staff Training & Development Coordinator states S1 was never hired, does not work for the facility, and is not in their Human Resources (HR) system.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Staff Training & Development Coordinator, Justin Williams and a copy of the report was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction