Office review·May 24, 2023

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Licen see/Administrator Christina Atencio and Paul Fulton (Paul will be the active Administrator once Admin Cert renewal is completed) Christina Atencio: Administrator to 1 facility Interview Method: Telephone interview On 5/24/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’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 New Licensees should create a Guardian account to manage their roster and assist future staff live scans without delays. To create a Guardian account, they will submit a Guardian Licensee User Access Form (LIC 9277LUA) to CDSS at GuardianLoginSupport@dss.ca.gov . A licensee/provider account will be created and CPMB will issue a new user notification email with a temporary password and link to the Guardian Agency portal. It is strongly recommended that the first step for an individual (i.e. new staff member) subject to background check should be to start the application process in Guardian rather than going directly to the Live Scan Vendor and submitting fingerprints. Proposed new staff will need to obtain an Applicant Instruction Form from the licensee which will provide a PIN code. This PIN will be required for new staff to submit an application in the Guardian system. Licensee will receive an alert of a new application to which the Licensee will choose to either ‘resume’ or ‘withdraw’. If resumed, Guardian will generate a prepopulated Live Scan form for the new staff to use when submitting their fingerprints to a Live Scan Vendor.