Senior Care Records.

Facility Evaluation Report

Family Senior Care Home I, San Jose11/17/2022Licence 435202876

Capacity6
Date signed11/17/2022 10:38:57 AM
The inspector’s account

Applicants/administrator participated in COMP II at CAB via Zoom video call with analyst at CAB. Identification of the applicants and administrator was verified by presenting photo ID via video. During COMP II, applicants and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicants and administrator were advised to email/fax signed LIC 809 to CAB.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:

1. Facility operation: License type, client/resident populations, and program

2. Staff qualifications and responsibilities

3. Applicant and Administrator qualifications

4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions

5. Grievances, Complaints, Community resources

7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property

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