Facility Evaluation Report, 05/04/2023 — Kingspine Senior Care Home, Rolling Hills Estate CA

Facility Evaluation Report

Kingspine Senior Care Home, Rolling Hills Estate05/04/2023Licence 198320380

Capacity6

Census5

Date signed10/10/2023 09:30:13 AM

The inspector’s account

COMP II Participants: Kathrina Buller (Applicant/Administrator)

On 5/4/2023, 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 and administrator confirmed the understanding of the 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

3. Staffing requirements/Guardian & Training

4. Restrictive/Prohibited Health Conditions

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