Senior Care Records.

Facility Evaluation Report

Alta Vista Simi #2 LLC, Simi Valley08/12/2022Licence 565850266

Capacity6
Date signed08/12/2022 02:15:02 PM
The inspector’s account

COMP II Participants: Emiliano Siapno , Administrator; Shannon Betker, analyst.

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

4. Applicant and Administrator qualifications

5. Grievances, Complaints, Community resources

8. Application document review and technical assistance: Pre-licensing inspection

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