Follow-up·June 14, 2021

COMP II by CAB successfully completed. Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): None COMP II Participants: Samuel Padama Interview Method: Telephone interview On June 14, 2021 at 11:00 AM , Administrator participated in COMP II at CAB via telephone with analyst, Celia Phomphachanh at CAB. Identification of the Licensee was verified by providing California Driver License number. During COMP II, applicant confirmed the understanding of Title 22. Component II was successfully completed. Administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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 qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property Interviewed concluded, LIC 809 will be sent via email to Administrator.