Facility Evaluation Report

COMP II Participants: Mona Alcaraz (Applicant) and Robin Aquino (Administrator)

Applicant/Administrator participated in COMP II at CAB via telephone with analyst at CAB. Identification of the Applicant and Administrator was verified by providing California Driver License number. During COMP II, Applicant and Administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and Administrator were advised to email/fax 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

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

In addition, Applicant/Administrator acknowledged the full understanding of the questions below:

1. Do you know what an excluded individual means? It means, you cannot have any excluded individual in or working for your facility.

Mona Alcaraz replied, “Yes, I understand”.

2. Do you know that Bioseh is lifetime excluded? Meaning he/she cannot have any part of your facility operations nor can he/she be around or in the facility nor have any contact with facility clients.

Mona Alcaraz replied, “Yes, I understand”.

3. Do you understand that if you have any excluded persons as part of your facility or present in your facility that you can be cited for noncompliance, fined and have your license revoked?

Mona Alcaraz replied, “Yes, I understand”.