Facility Evaluation Report
Capacity6
Census5
Date signed12/08/2025 02:13:13 PM
Name of licensing program analystElias Magdaleno
Name of licensing program managerVictoria Bertozzi
At approximately 1:50 PM Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a case management-other visit and met with House Manager Margaret Henley.
The purpose of this visit was to follow up on a Death Report submitted by facility on 12/2/2025. LPA conducted interviews and collected documents. LPA requested Death Certificate to be submitted to CCL as soon as available. More information is required.
No deficiencies cited. Exit interview conducted with House Manager, whose signature on form confirms receipt.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction