Facility Evaluation Report

Licensing Program Analysts (LPAs) Misty Valencia and Shannon Diegoruelas arrived at the facility announced on 01/27/2022 to conduct visit regarding Pre-Licensing and Comp lll Orientation. LPAs met with Paula Davis, Regional Director, and Simonie Webster, Program Adminitrator and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Facility Representative and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 masks. Additionally, LPA was screened at the fornt door before entrance.

COMP II, has been completed by Centralized Application Bureau analyst who 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. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulations.