Facility Evaluation Report
Capacity6
Census2
Date signed08/08/2025 10:24:23 AM
Name of licensing program analystZabel Chochian
Name of licensing program managerDesaree Perera
This Case management visit was conducted to address the deficiency noted during complaint investigation visit conducted on 08/07/2025.
Resident files observed incomplete - for Resident #1 missing Appraisal/Needs and services plan, physician report and admission agreement. For Resident #2 - missing current physician report and Appraisal/needs and service plan.
Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D):
Exit interview conducted. Copy of this report and appeal rights provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction