Office review·April 25, 2024

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 4 (converting from CHLF to RCFE) COMP II Participants: Mari Dee Sandra Cid (goes by Sandra) Interview Method: Telephone interview On April 25, 2024, 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. Staff/training/medications 3. Pre-licensing readiness 4. Conversion to RCFE/documents 5. General provisions