Senior Care Records.

Facility Evaluation Report

Orange Senior Home INC., Yorba Linda03/03/2025Licence 306006691

Capacity6
Census0
Date signed03/03/2025 03:50:17 PM
The inspector’s account

COMP II Participants: TAE SUN KIM(Administrator/Licensee) & JOSHUA DEGMETICH (Analyst).

Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB.

During COMP II, CAB analyst confirmed Administrator/Licensee's understanding of following areas:

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

4. Restrictive/Prohibited Health Conditions

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