Senior Care Records.

Facility Evaluation Report

Millbrae Assisted Living Home, Millbrae10/01/2021Licence 415601112

Capacity48
Date signed10/01/2021 11:29:05 AM
The inspector’s account

COMP II Participants: Lucero, Mary Ann, Po, Ginger

On 10/01/2021, Ginger Po and Mary Ann Lucero 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 the understanding of the California Code Title 22 Regulations. 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