Facility Evaluation Report

Facility Type: ARF Application Type: INITL Capacity: 4

COMP II Participants: Gerald Jones, Administrator and Corporate board member, and Kevin Clark, Corporate board member. Interview Method: Telephone interview

On 8/11/2021, applicants and 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. A copy of PIN 20-48-ASC has been provided to the applicant as well.

During COMP II, CAB analyst confirmed Applicants' and Administrator's understanding of following areas:

1. Facility operation: License type, client/resident populations, and program

4. Restrictive/Prohibited Health Conditions