Office review·October 26, 2022

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Merilyn Bergstrom(Applicant/Administrator) Interview Method: Telephone interview with CAB Applicant/Administrator participated in COMP II. During COMP II, Applicant/ Administrator confirmed the understanding of the California Code Title 22 Regulations. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Applicant and Administrator qualifications 3. Staff Qualifications - hiring procedures, responsibilities; training 4. Program policies -restricted/prohibited health conditions, medication management; incident reporting to CCLD; food service and management, Activities program 5. Grievances, Complaints, Community resources; Abuse reporting 6. Application document review and technical assistance- Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator Certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property