Guardian Angels Board and Care

Allegation investigated: Staff do not ensure resident's showering needs are being met Staff do not ensure the facility is properly maintained Staff speak inappropriately to resident Staff do not provide adequate food service

At 9:00am, Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced visit in response to the above-mentioned allegations. LPA met with Staff #1 (S1), who granted access to the facility. The Administrator arrived shortly after and LPA expalined the reason for the visit. At 9:05am, LPA requested resident and staff roster. At 9:10am, requested copies of pertinent information which include, but not limited to Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Facility Menu, Incontinent Plan of Care/Policy, Bedridden Plan of Care/Policy, Employee Misconduct Policy, Staff Training, etc., relevant to the investigation. At approximately 9:20am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 9:30am - 11:30am, LPA conducted an interview with the Administrator, one (1) staff and five (5) residents. Continue on LIC9099-C Unsubstantiated Staff do not ensure resident's showering needs are being met To investigate this allegation, LPA conducted an interview with the Administrator who denied the allegation and stated that no complaints were received from the residents regarding missed showers. Additionally, the Administrator stated that the facility maintains an established shower schedule tailored to each resident’s needs and preferences. The Administrator reported that all residents are provided with at least two (2) showers a week or as needed. Staff interviewed denied the above allegation and reported that they do meet residents’ showering needs and always ensure residents’ hygiene needs are addressed. Furthermore, staff indicated that they assist residents with bathing according to their care plans and residents’ preference. Staff stated that residents are regularly offered showers, and if a resident declines, the shower is rescheduled for later the same day or the following day. Five (5) residents interviewed stated that staff offer showers regularly. Residents also reported receiving assistance as needed and did not express concerns about missing showers. Lastly, during the facility tour, the LPA observed residents appeared clean, groomed, and appropriately dressed. Shower areas were clean, stocked, and accessible. Based on interviews and LPA observation, there is not enough evidence to support the allegation. Therefore, this allegation is deemed Unsubstantiated at this time. Staff do not ensure the facility is properly maintained To investigate this allegation, LPA conducted an interview with the Administrator, who reported visiting the facility daily and stated they have not observed any maintenance problems. The Administrator added that any issues reported by residents or staff are addressed promptly. One (1) staff interviewed reported that they follow daily cleaning routines, promptly inform the Administrator of any repair needs, and regularly clean common areas, resident rooms, and bathrooms. Staff denied that the facility is poorly maintained. Five (5) residents interviewed expressed that the facility is generally clean and well-kept. Residents reported that staff respond to any concerns they bring forward, such as minor repairs or cleanliness issues. Lastly, during the physical walk through, LPA observed that the facility appeared clean and in good repair. Common areas and resident rooms were free from clutter, and bathrooms were clean and stocked. No immediate maintenance issues or hazards were observed. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated at this time. Continue on LIC9099-C Staff speak inappropriately to resident To investigate this allegation, LPA conducted and interview with the Administrator who denied the allegation and stated they have not received complaints or witnessed staff speaking inappropriately to residents. The Administrator stated that staff are trained on resident personal rights, respectful communication, and professional conduct during orientation and ongoing in-service training. The Administrator reported that any misconduct is addressed immediately in accordance with the facility’s employee discipline policy. Staff interviewed reported that they are expected to speak respectfully to residents at all times and are trained in the facility’s house rules and personal rights policies. Staff denied speaking inappropriately to any residents and stated they communicate calmly and professionally when providing care or redirecting behaviors. Five (5) residents interviewed stated that staff generally speak to them in a respectful manner. Residents reported feeling comfortable approaching staff and did not report any incidents of staff using inappropriate or disrespectful language. No residents corroborated the allegation. LPA reviewed the facility’s employee misconduct policy, house rules, and resident personal rights postings. The documents outline expectations for professional conduct, respectful communication, and procedures for addressing inappropriate staff behavior. Lastly, during the facility tour, LPA observed staff interacting with residents in a calm, respectful manner. Staff were observed offering assistance and responding to questions politely. No inappropriate communication was observed during the visit. Therefore, based on interviews and LPA observation, this allegation is deemed Unsubstantiated at this time. Staff do not provide adequate food service To investigate this allegation, LPA conducted an interview with the Administrator and was informed that they purchase groceries once a week (Saturday) or as needed. The Administrator denied the allegation and stated that the facility provides three (3) meals per day and snacks in accordance with Title 22 requirements. The Administrator reported that the facility follows the weekly menu, food orders are placed regularly, and staff are trained to ensure meals meet nutritional guidelines. Staff interviewed stated that adequate food supplies are maintained in the facility and that meals are prepared fresh daily. Staff reported that residents are offered substitutes if they do not prefer the main meal and that snacks are available between meals. Continue on LIC9099-C Staff informed LPA that they adjust meals according to residents’ dietary needs. Five (5) residents interviewed stated that the food served is adequate and that meals are provided on time. All residents informed LPA that they receive enough food and have access to snacks. No resident reported experiencing periods where food was insufficient/inadequate. LPA conducted a food supply inspection and observed that the facility had an adequate supply of perishable and non-perishable food items in accordance with regulatory requirements. LPA observed staff preparing a fresh, well-portioned lunch consisting of rice with tomato sauce, broccoli, chicken, orange juice, and fresh grapes. Based on interviews and LPA inspection of the food supply and lunch preparation, there was not enough evidence to support the allegation. Therefore, this allegation is deemed Unsubstantiated at this time. No deficiency issued during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Sep 15, 2026 · control 31-AS-20260910094730

Allegation investigated: Staff is abusing resident.

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with staff, Tracy Mambwe, and advised her of the complaint. The administrator, Gor Khurshudya, was advised over the telephone. It was reported that Staff 1 (S1) has hit and thrown Resident 1 (R1) to the ground. There were no witnesses identified to this allegation, or date and time specified. Moreover, included to this report was that R1's physical exam at the hospital did not show evidence of significant assault, and R1 has made this claim before. Today's investigation consisted of interviews with the administrator and staff, held between 12:15pm to 12:45pm, interviews with four (4) residents, held between 12:45pm to 1:15pm, a physical plant inspection, held between 1:15pm to 2:00pm, and record review, held between 2:00pm to 2:30pm. Regarding allegation: Staff is abusing resident, Interviews with the administrator and staff deny the allegation Unsubstantiated of abusing R1 or any of the facility residents. R1 has trouble adjusting socially, is impaired in decision making, and has made allegations similar to this in the past. R1 moved out of the facility voluntarily 06/01/26, and will not be returning. Administrator and staff does not know where R1 moved to. R1 only stayed at this facility for about one month. Interviews with four (4) of the four residents could not confirm the allegation. These residents expressed no complaints or concerns regarding care and supervision provided, adding their needs are met. Residents also deny that the administrator or staff has ever mistreated them, or been inappropriate towards them. Review of R1's records indicate some confusion and paranoia. Based on the department’s observations, interviews which were conducted, and record reviews made, there was insufficient evidence to prove that staff is abusing residents. Therefore the above allegation is deemed Unsubstantiated at this time. Staff advised and a copy of this report issued.the state’s words, verbatim · CDSS document, Jun 12, 2026 · control 31-AS-20260604164604

Allegation investigated: Staff is abusing resident.

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with staff, Tracy Mambwe, and advised her of the complaint. The administrator, Gor Khurshudya, was advised over the telephone. It was reported that Staff 1 (S1) has hit and thrown Resident 1 (R1) to the ground. There were no witnesses identified to this allegation, or date and time specified. Moreover, included to this report was that R1's physical exam at the hospital did not show evidence of significant assault, and R1 has made this claim before. Today's investigation consisted of interviews with the administrator and staff, held between 12:15pm to 12:45pm, interviews with four (4) residents, held between 12:45pm to 1:15pm, a physical plant inspection, held between 1:15pm to 2:00pm, and record review, held between 2:00pm to 2:30pm. Regarding allegation: Staff is abusing resident, Interviews with the administrator and staff deny the allegation Unsubstantiated of abusing R1 or any of the facility residents. R1 has trouble adjusting socially, is impaired in decision making, and has made allegations similar to this in the past. R1 moved out of the facility voluntarily 06/01/26, and will not be returning. Administrator and staff does not know where R1 moved to. R1 only stayed at this facility for about one month. Interviews with four (4) of the four residents could not confirm the allegation. These residents expressed no complaints or concerns regarding care and supervision provided, adding their needs are met. Residents also deny that the administrator or staff has ever mistreated them, or been inappropriate towards them. Review of R1's records indicate some confusion and paranoia. Based on the department’s observations, interviews which were conducted, and record reviews made, there was insufficient evidence to prove that staff is abusing residents. Therefore the above allegation is deemed Unsubstantiated at this time. Staff advised and a copy of this report issued.the state’s words, verbatim · CDSS document, Jun 12, 2026 · control 31-AS-20260604164604

Allegation investigated: Staff do not ensure that resident's incontinence needs are met Facility smelled malodorous Staff did not assist resident with bathing Staff did not assist resident with grooming Staff do not assist residents with obtaining medical care Staff do not assist resident with ambulating

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to conclude the investigation regarding the above allegations. LPA met with the administrator, Flora Kerobyan, and advised her of the complaint. The initial ten day visit was made by LPA Cava on 11/13/25. At that time, LPA interviewed the administrator, staff and six (6) residents. LPA also conducted a physical plant inspection and record review. Today's visit consisted of additional interviews with the administrator and staff, that was held between 8:30am to 9:30am, interviews with three residents, that was held between 9:30am to 10:30am, a physical plant inspection, that was held between 10:30am to 12:00pm, and reviewing and obtaining copes of resident records, that held between 12:00pm to 1:30pm. Staff do not ensure that resident's incontinence needs are met/Staff did not assist resident with bathing/ Staff did not assist resident with grooming: Unsubstantiated In regards to the allegations from the previous page, it was reported that Resident 1 (R1) was observed in a soiled diaper, and smelled of urine and feces. It appeared that R1's face had not been washed and there was food all over R1's clothes. In addition, R1 was not properly clothed as R1 was lying under a sheet with only a diaper on. There were no witneses provided to corroborate with these allegations. During the initial ten (10) day visit made by LPA Cava, LPA had the opportunity to interview R1, who had no complaints or concerns to report regarding the facility. R1 stated their needs are met. Staff assists with bathing, going to the bathroom for toileting needs, getting in and out of bed, going on and off their wheelchair, and change of clothes. R1 gave no indication of neglect, and was satisfied with needs provided. During the interiew, LPA observed R1 to be appropriately cared for. Today, LPA conducted interviews with administrator and staff, who both deny the allegation of neglecting R1 or any other of the residents in care. LPA also interviewed three (3) of three residents between 9:30am to 10:30am. Interviews made with these residents do not corroborate with these allegations. LPA conducted a record review of R1's Medical Assessment, Appraisals, and Functional Capabilities. These records do confirm that R1 require assistance with bathing, grooming and toileting needs. Although there is information that reveal R1 requires some assistance with her Activities of Daily Living (ADL), there is insufficient evidence to prove that Staff do not ensure that resident's incontinence needs are met, Staff did not assist resident with bathing, and Staff did not assist resident with grooming. Therefore, allegations are deemed Unsubstantiated at this time. Facility smelled malodorous: In regards to the allegation, it was reported that facility and R1's room smelled of urine and feces during a visit to the home on or around 11/05/25. No witnesses were provided to confirm the allegation. During LPA's ten day visit, made on 11/13/25, a physical plant inspection was made. LPA did not notice a smell of urine and feces during that visit. Interviews with administrator, staff and residents made shared no complaints or concerns, denying the facility smelled malodorous. LPA conducted another physical plant inspection today, 03/13/26, and did not notice facility smelling of urine or feces. Interviews with the three residents, who were present during this visit, had no complaints regarding the physical plant ever smelling malodorous. Based on the information obtained, there was not enough evidence to confirm the above allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Staff do not assist residents with obtaining medical care: In regards to the allegation, it was reported that another female resident, who was unidentified to the complaint, is not receiving physical therapy (PT). Reporter was unable to provide a name to the resident, only stating this resident needs physical therapy. Interviews with the administrator and staff deny the allegation stating their current residents do not require physical therapy at this time. Administrator did state that facility did have residents that required PT, but that was ordered by the resident's doctor, and facility complied by allowing PT to be given at facility. During ten day visit, interviews were made with residents, who could not corroborate with the allegation. Today interviews made with three (3) residents, who's interviews still do not corroborate with the allegation. Based on the information obtained, it could not be proven that staff do not assist residents with obtaining medical care. Therefore, the allegation is deemed Unsubstantiated at this time. Staff do not assist resident with ambulating: In regards to the allegation, it was reported that R1 has pain when they ambulate and can't bend their legs. Moreover, staff is not repositioning R1. Interviews with administrator and staff deny the allegation. Administrator acknowledged that R1 is non-ambulatory, but did not require assistance with repositioning. R1 required and was given physical therapy (PT) at the convalescent home they stayed at prior to admission to this facility, but wasn't given an order for PT at admission. Moreover, both administrator and staff stated that they assist R1 to and from the wheelchair, and on to the dining room and common areas. During the visit on 11/13/25, R1 confirmed staff assists them with ambulating and expressed no complaints or concerns about not getting assistance. R1 indicated their needs were being met. During today's visit, review of R1's medical assessment and appraisals reveal R1 is non-ambulatory requires the use of a wheelchair, and has limited mobility. LPA unable to interview R1 during this visit, as R1 passed away on 12/15/25. Interviews held with three residents during today's visit was inconsistent with the allegations, as these residents stated their needs are met, and receives help when they need assistance with ambulating about the facility. Based on the information obtained, it could not be proven that staff do not assist resident with ambulating. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Mar 13, 2026 · control 31-AS-20251106161948

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the Licensee, Gor Khurshudyan, and explained the reason for the visit. At approximately 9:30am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual, hardwired and interconnected. The fire extinguishers is located in the kitchen. It was purchased on March 4, 2025 Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food properly stored. Knives were stored in a locked drawer in the kitchen. No cleaning supplies observed out in the open. Cleaning supplies were checked and observed locked in a closet by the living room. Bedrooms: There are four (4) bedrooms designated for residents' use. Bedroom #1 is private. Bedrooms #2, #3, and #4 are shared. Per STD 850, bedroom #2 only has a bedridden fire clearance. Bedrooms were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: The facility has three (3) bathrooms. All three bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 117 to 120 degrees. There were no cleaning supplies observed in any of the bathrooms during the day's visit. COMMON AREAS: Common areas include the living room and dining room. The living room is furnished with sufficient seating, couches, recliners, tables and television. The dining room table is large enough to seat six (6) residents. Furniture in common areas are observed to be in good repair. Floors were mopped and clean. Entry/exits, hallways and passageways were clear. GARAGE/LAUNDRY ROOM: The garage is connected to the building. It is used for storage. Garage was locked during the day of the visit. LAUNDRY ROOM: The laundry area is also in the garage, where detergent and softeners are kept locked and inaccessible to residents in care. OFFICE/STAFF WORKSTATION: Staff office is located across from the living room and dining room, where staff and resident records are kept locked in a cabinet. 1st aid kit and manual also maintained in the staff office. MEDICATIONS: Medications are kept locked at a cabinet, in staff office. Medication and medication records were reviewed for proper storage and documentation. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The floors and passageways were clean and in good repair. The backyard of the facility has a patio area and backyard furniture to accommodate the six (6) residents. The facility backyard also has sufficient yard space to hold outdoor activities. There is a swimming pool that is fenced all around with a gate that will be kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around its parameters. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Jan 24, 2026

Allegation investigated: Resident sustained an injury due to staff neglect or physical abuse

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with the administrator, Gor Khurshudyan, and advised him of the complaint. Today's investigation consisted of interviews with the administrator, staff and residents. LPA also conducted a physical plant inspection and record review. In regards to the allegation, it was reported that on or around 12/09/25, Resident1 (R1) sustained an unexplained injury due to staff neglect or abuse. It was also unclear on how long R1 was left unattended if R1 did experience a fall, resulting in these injuries. Reporting party did not identify any witnesses that can corroborate with this allegation. Between 10:00am to 11:00am, interviews with the administrator and staff deny the allegation of neglect and abuse. Both stated that on or around 12/09/25, R1 experienced a fall. Paramedics were called immediatly Unsubstantiated for medical attention to treat R1's injuries. R1 was then taken to the hospital for evaluation and treatment. Administrator provided LPA a copy of facility incident report, explaining R1's fall, and steps staff took to address the fall and R1's injury. At approximately 11:00am to 12:00pm, interviews with four (4) of four residents were made. LPA could not interview R1 as R1 was still at the hospital. Interviews with the four residents that are present in the facility could not confirm the allegation. At approximately 12:00pm to 2:00pm, LPA made a physical plant inspection and record review to insure facility compliance. At approximately 2:00pm to 2:30pm, LPA spoke with R1's responsible person, who confirmed R1's diagnosis and non-ambulatory/bedridden status, which can lead to falls. R1's responsible person placed no fault with facility, stating the incident is an accident. R1's responsible person also adds that while R1 was at the hospital, R1 also suffered another fall. Based on the information obtained, there is insufficient evidence to prove that R1 sustained an injury due to staff neglect or physical abuse. Therefore the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Dec 18, 2025 · control 31-AS-20251215223802

Allegation investigated: Staff did not meet resident's care needs. Staff did not allow resident to continue hospice services of resident's choice.

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to conclude the investigation regarding the above allegations. LPA met with the administrator, Gor Khurshudyan and advised him of the allegations. LPAs investigation consisted of intervies with the administrator, staff and residents. LPA also conducted a record review and a physical plant inspection to insure facility compliance with regulation. Regarding the above allegations, it was reported that the licensee would not allow for Resident 1 (R1) to receive hospice services from an agency of R1's preference. R1 would have to receive hospice services from an agency recommended by the licensee. As a result, R1's care needs were not met. Interviews with the Administrator and Staff 1 (S1) deny both allegations. According to both, R1 was given the right to choose what hospice agency to provide service for at admission. R1 was admitted on or around 03/08/25, but moved out two weeks later because R1 required a higher level of care that the licensee Unsubstantiated could not provide. Administrator stated R1 went to the hospital, and then to a post acute center. Administrator adds that R1 would not be returning to the facility based on their needs. Interviews with R1's Family (RF) and Family Friend (FF) also deny both allegations. Both RF and FF confirm that R1 only stayed at the facility for about a week, but had no complaints regarding facility services. Both stated, in that time they were happy with the care provided by the licensee and facility staff, and expressed regret that R1 had to be transferred for a higher level of care. When asked if staff was able to meet R1's needs, both RF and FF stated yes, R1's needs were met. The main complaint or concern was with the hospice agency. Both RF and FF stated hospice took to long to process R1's paperwork for R1 to receive physical therapy. Both RF and FF stated the facility administrator tried his best to help as much as he can to assist in getting the paperwork, to no result. Both RF and FF reiterate that the administrator did not force R1 to choose a hospice agency of the licensee's choice, or threaten to not allow R1 to continue with the hospice service of R1's choice. Both RF and FF add that R1 is still capable of making decisions. Interview with three (3) of three residents deny the allegations of not being able to select a hospice agency of their choice, or staff not meeting their needs. Telephone interview with R1 confirm that this complaint is not meant towards the facility, but for the hospice agency that caused a delay in processing the hospice paperwork. When interviewed, R1 was happy with care and service provided by facility staff, and staff was able to meet R1's needs for the short stay there at the facility. Based on the information obtained, it could not be proven that "Staff did not meet resident's care needs and Staff did not allow resident to continue hospice services of resident's choice". Therefore, both allegations are deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Jul 26, 2025 · control 31-AS-20250403084147

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representative and the administrator, Gor Khurshudyan and Silva Sashikyan. Their consultant, Lusina Tadevosyan, was also present. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on May 3, 2024. A fire clearance was approved on June 26, 2024 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. The applicant is also requesting a hospice waiver to retain a total of five (5) residents. The faciilty is a one story building. The smoke alarms and carbon monoxide detector are hard wired and inter-connected. The facility has a new fire extinguishers that was purchased on May 9, 2024. It is located in the kitchen. A tour of the physical plant was initiated at approximately 10:30am and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives will be kept in a locked drawer. Cleaning supplies will be kept in a locked cabinet beneath the sink. There is also an additional dining room table for staff. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #1 is private. Bedrooms #2, #3 and #4 are shared. Per STD 850, bedroom #2 only has a bedridden fire clearance. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has three (3) bathrooms. All three bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 111 to 116 degrees. COMMON AREAS: These included the living room and dining room. The living room is equipped with three couches, two chairs, two tables, and a television. There is no fireplace. The dining room has a table large enough to seat between six (6) to eight (8) individuals. Dining room has an additional couch and coffee table. Bookshelf in the dining room carries some board games. GARAGE/LAUNDRY ROOM: The laundry area is in the garage. The garage will also be utilized for storage, and will be kept locked and inaccessible to the residents. OFFICE/STAFF WORKSTATION: Office is located across from the living room and dining room, where staff and resident records will be kept locked in a cabinet. 1st aid kit and manual also maintained in the staff office. MEDICATIONS: Medications and medication records will be kept in another locked cabinet in the office. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The floors and passageways were clean and in good repair. The backyard of the facility has a patio area and backyard furniture to accommodate the six (6) residents. The facility backyard also has sufficient yard space to hold outdoor activities. There is a swimming pool that is fenced all around with a gate that will be kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around its parameters. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held prior to the physical plant inspection. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 24, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB On 10/3/24, the 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. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 3, 2024