Senior Care Records.

Facility Evaluation Report

Our Countryside Resort, Perris10/08/2024Licence 331881645

Capacity36
Census17
Date signed10/08/2024 11:48:17 AM
The inspector’s account

COMP II Participants: Elizabeth Mahan (Administrator) & Lucia Ramos (Board Member)

Interview Method: Virtual interview via Microsoft Teams

On October 08, 2024, applicant/administrator participated in COMP II. 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 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

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