Facility Evaluation Report, 03/27/2023 — Angelica's Home, INC., Temecula CA

Facility Evaluation Report

Angelica's Home, INC., Temecula03/27/2023Licence 331881415

Capacity6

Census0

Date signed03/27/2023 11:35:42 AM

The inspector’s account

Facility Type: Residential Care Facility for Elderly (RCFE)

COMP II Participants: Kenneth Oosting, Applicant

Angelica Oosting, Applicant/ Administrator

On March 27, 2023 at 10: 15 AM, Applicant and 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.

During COMP II, CAB Analyst confirmed Applicant and Administrator’s understanding of following areas:

1. Facility operation: License type, Client/resident Populations, and Program.

4. Restrictive/Prohibited Health Conditions

Exit interview conducted with Applicant and Administrator. Copy of report sent via email and informed to return sign copy by close of business today.

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