Facility Evaluation Report
Capacity6
Census3
Date signed01/16/2025 09:50:23 AM
On 01/16/2025, Licensing Program Analyst (LPA) Ivan Avila arrived unannounced at the facility to conduct a case management visit regarding an incident report the Department received via fax on 01/15/2025. LPA met with Angel Doss, Administrator, on behalf of the facility and explained the purpose of the visit.
LPA Avila collected documents in regard to the incident report. Documents collected include but are not limited to client face sheet, physician report, needs and service plan, conservator ship documents, progress notes, client IPP, and medical documentation.
An exit interview was conducted and a copy of the report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction