Senior Care Records.

Facility Evaluation Report

Dos Palmas Residential Care, Victoriville04/15/2024Licence 365530192

Capacity4
Census0
Date signed04/15/2024 04:30:26 PM
The inspector’s account

Facility Type: Adult Residential Facility (ARF)

COMP II Participants: David Adubi, Administrator/Applicant

On April 15, 2024 at 3:15 PM , applicant/administrator participated in COMP II. Identification of the applicantadmi/nistrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/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/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 Administrator/Applicant. Report sent via email and informed to return sign copy to CAB by 4/16/2024.

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