Senior Care Records.

Facility Evaluation Report

Rincon Valley Assisted Living LLC, Santa Rosa05/11/2023Licence 496804133

Capacity6
Census2
Date signed05/11/2023 03:22:15 PM
The inspector’s account

Facility Type: Residential Care Facility for Elderly (RCFE)

Application Type: Change in Ownership (CHOW)

COMP II Participants: Fikre Gurja, Applicant/Administrator

On May 11, 2023 at 1:10 PM , Applicant/Administrator participated in COMP II. Identification of the Applicant/ Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22.

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

Exit interview conducted with Applicant/Administrator. Copy of report email pdf and informed to return sign copy to CAB by end of business day today.

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