Senior Care Records.

Facility Evaluation Report

Serene Haven Home, South San Francisco08/05/2024Licence 415601183

Capacity4
Census4
Date signed09/18/2024 07:15:45 AM
The inspector’s account

COMP II Participants: Bill Fajardo (Administrator/Licensee ), Claire Ascalon (Licensee), Esperanza Sorongon (Licensee), & Tammy Edwards (Analyst).

Administrator/Licensees participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensees were verified by confirming driver’s license numbers. During COMP II, Administrator/Licensees confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensees were advised to email signed LIC 809 with copy of photo ID to CAB.

During COMP II, CAB analyst confirmed Administrator/Licensee'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