Facility Evaluation Report

Samantha's Home, Santa Ana07/22/2022Licence 306006188

Capacity6
Census4
Date signed07/10/2023 10:12:00 AM
The inspector’s account

COMP II Participants: Maria Kabiling; Romeo Zano

Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:

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

2. Staff qualifications and responsibilities

3. Applicant and Administrator qualifications

4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions

5. Grievances, Complaints, Community resources

7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property

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