Senior Care Records.

Facility Evaluation Report

Revival Home Care LLC, Chula Vista09/09/2024Licence 374604742

Capacity4
Census0
Date signed09/09/2024 02:46:06 PM
The inspector’s account

Facility Type: Adult Residential Facility (ARF)

COMP II Participants: Josefina So, Applicant/Administrator

On September 9, 2024 at 10:00AM, 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/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. Report sent via email and informed to return sign copy to CAB by end of business day today.

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