Senior Care Records.

Facility Evaluation Report

Kala Springs, Shingle Springs05/16/2025Licence 095920251

Capacity4
Date signed05/16/2025 01:29:41 PM
Name of licensing program analystAnna Barrios
Name of licensing program managerTracy Thompson
The inspector’s account

COMP II Participant: Jesus Ramirez, Administrator

On 5/16/25, administrator participated in COMP II. Identification of the administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, 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 Administrator’s understanding of following areas:

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