Office review·December 17, 2021

Component II completion: Unsuccessful Facility Type: RCFE Application Type: Change of Ownership (CHOW) Capacity: 6 Census (if any clients in care): 4 (3 non-ambulatory, and 1 bedridden) COMP II Participants: Marcelina Badeo, Administrator Interview Method: Telephone interview On December 17, 2021 at 10:00 AM , Administrator participated in COMP II. Identification of the Administrator was verified through interview questions based on photo ID and other identifying personal information. Administrator did not provide sufficient knowledge the program and the California Code Title 22 Regulations. Component II will be rescheduled. Exit interview conducted with Administrator and LIC 809 sent to Administrator via email. Administrator informed to return sign LIC 809 to CCLD before next COMP II.