Facility Evaluation Report

Moonraker Villa Senior Care 2, Hayward01/25/2024Licence 019201338

Capacity6
Census0
Date signed04/05/2024 07:01:00 AM
The inspector’s account

COMP II Participants: Name -Yong Akaosugi (Applicant)/(Administrator)

On January 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/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 the

1. Facility operation: License type, client/resident populations, and program

4. Restrictive/Prohibited Health Conditions

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction