Senior Care Records.

Facility Evaluation Report

Pendleton House, Sun Valley01/20/2023Licence 197610354

Capacity6
Date signed01/20/2023 02:31:25 PM
The inspector’s account

COMP II Participant: Mary Maro Karibian, CEO/Administrator

On 1/20/23, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/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 Applicant/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