Senior Care Records.

Facility Evaluation Report

Kasa Jomi, South San Francisco11/05/2021Licence 415601109

Capacity4
Date signed11/05/2021 03:54:56 PM
The inspector’s account

COMP II Participants: Jobelle Huertas (Administrator/ Applicant/licensee); Kaycee Huertas (applicant/licensee)

On 11/5/2021, 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 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