Facility Evaluation Report

On [05/31/2024], applicant(s)/administrator participated in COMP II for the below pending facilities: [list out all of the applicable pending applications in the following format: FACILITY NAME/FACILITY #, ex. Front Street Facility/123456789, Back Alley Facility/987654321, etc…]. Identification of the applicant(s) and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant(s) and 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