Office review·January 18, 2022

Component II completion: Successful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Myline Olivas, Administrator/Licensee Interview Method: Telephone interview On January 18, 2022 at 9:00 AM, Administrator/Licensee participated in COMP II. Identification of the Administrator/Licensee was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Administrator/Licensee confirmed the understanding of the California Code Title 22 Regulations. During COMP II, CAB analyst confirmed Administrator/Licensee’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Administrator/Licensee. Report sent via PDF email and Administrator/Licensee will return signed copy.