Senior Care Records.

Facility Evaluation Report

A Peaceful Haven Residential Community, Sylmar09/24/2024Licence 197610626

Capacity6
Date signed09/24/2024 01:30:45 PM
The inspector’s account

Facility Type: Residential Care Facility for the Elderly

COMP II Participants: CLAUDIA GUTIERREZ, LUCY GUTIERREZ

On September 24, 2024, 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

4. Restricted/Prohibited Health Conditions

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