Facility Evaluation Report, 04/14/2023 — Heavenly Care Home, Newark CA

Facility Evaluation Report

Heavenly Care Home, Newark04/14/2023Licence 019201259

Capacity6

Census0

Date signed04/27/2023 01:58:02 PM

The inspector’s account

COMP II Participants: Bushra Shahid CEO/ Shahid Abbasi Administrator

On April 14, 2023, 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