Office review·February 7, 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: Manuel Sandoval Interview Method: Telephone interview On February 7, 2022 at 11:00 AM, 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, Administrator confirmed the understanding of the California Code Title 22 Regulations. During COMP II, CAB analyst confirmed 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 Exit interview conducted with Administrator. Copy sent via PDF email and advised Administrator to return signed copy to Analyst.