Office review·October 15, 2024

Component II completion: Successful Facility Type: RCFE Application Type: INTL Capacity: 6 Census : 0 Method: Telephone call with CAB COMP II Participants: Shabana Buksh (Administrator/Licensee) & Tammy Edwards (Analyst). Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. 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 Applicant Not allowed to accept dementia residents with ambulatory only clearance