Senior Care Records.

Facility Evaluation Report

Millhaven Home, San Jose01/30/2023Licence 435202886

Capacity6
Date signed01/30/2023 09:38:23 AM
The inspector’s account

Facility Type: Adult Residential Facility

On January 30, 2023, 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. Restricted/Prohibited Health Conditions

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