Facility Evaluation Report

Facility Type: Residential Care Facility for the Elderly (RCFE)

Application Type: Change in Ownership (CHOW)

COMP II Participants: J i mmy Broines, Applicant/Administrator

On October 2, 2024 at 1:00 PM, 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

Exit interview conducted with Applicant/Administrator. Report sent via email and informed to return sign copy back to CAB by end of business day today.