Facility Evaluation Report

Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant/administrator was verified by correctly answering identity verification questions. During COMP II, applicant/administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant/ administrator has been advised to transmit 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

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