Senior Care Records.

Facility Evaluation Report

Extraordinary Living GP, Perris03/03/2025Licence 331881703

Capacity4
Census0
Date signed04/10/2025 05:55:04 AM
Name of licensing program analystTammy Edwards
Name of licensing program managerHao Nguyen
The inspector’s account

COMP II Participants: Jacquiece Parker (Administrator/Licensee) & Tammy Edwards (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