Office review·March 21, 2022

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Change of Ownership (CHOW) Capacity: 6 Census (if any clients in care): 2 COMP II Participants: Mohamed Massaquoi, Administrator Interview Method: Telephone interview On March 21, 2022, Administrator participated in COMP II. Identification of the 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 with Administrator. Report sent via PDF email and informed Administrator to return signed copy back by end of business day.