Facility Evaluation Report

Facility Type: RCFE Application Type: INITL Capacity: 6 COMP II Participants: Marilen Gonzales Interview Method: Telephone interview

On 12/21/21, applicant 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 confirmed understanding of California Code Title 22 Regulations. 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

4. Restrictive/Prohibited Health Conditions