Senior Care Records.

Facility Evaluation Report

Northpark Manor, Roseville10/21/2022Licence 315002963

Capacity6
Census0
Date signed10/21/2022 12:25:34 PM
The inspector’s account

COMP II Participants: Georgeta Iacob (Corporate Board Member and Administrator)

On October 21, 2022, applicant/administrator participated in COMP II via telephone call with the analyst at CAB. 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 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