Office review·September 1, 2022

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 250 Census (if any clients in care): 175 COMP II Participants: Cynthia Williams (applicant/licensee rep./administrator) Interview Method: Telephone interview On 09/01/2022, 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 the understanding of the California Code Title 22 Regulations. 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