Facility Evaluation Report
On 11/24/2025, Licensing Program Analyst (LPA) Gorban arrived unannounced conduct a Case Management deficiency visit. LPA introduce self, stated the purpose of the visit, and met with Resident Care Director Brittney Polman.
The purpose of the today's visit is to address an incident where requested records were not provided for resident (R1) by due date, as recorded, by November 14th, 2025. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached LIC 809D. In addition, LPA requested facility file- designation of facility responsibility by 11/26/2025
An exit interview was conducted. A copy of this report and appeal rights were provided to Resident Care Director, whose signature confirmed receipt of this report.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction