Anaheim Villa

Allegation investigated: Staff did not issue responsible party proper refund. Staff did not allow visitors.

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit upon entering the facility. The complaint investigation consisted of interviews with facility staff, resident family members, a witness, and a document review. Regarding the allegation: Staff did not issue responsible party proper refund. During the investigation it was discovered, Resident 1 (R1) and Resident 2 (R2) were both scheduled to be admitted to the facility; however only R1 was admitted. R2 did not want to stay at the facility and was eventually sent to the hospital. Room and board fees were paid for both residents for the month of March 2026. Eventually a credit was applied for R1 for the dates of March 17, 2026 – March 31, 2026. Continued on LIC9099C Unfounded The credit balance was applied to R2’s April monthly room and board fees as the family of the R2 wanted the room held for R1 at this time. On April 3, 2026, it was decided that R2 was not going to be moving into the facility and a credit was applied for the room and board fees for April 4, 2026, through April 30, 2026. The facility charged a room and board fee for three days (April 1 – 3) and deducted the amount from the credit balance and issued the remaining credit balance in a refund check dated June 26, 2026. A copy of the refund check and an accounting ledger of all the room and board fees that were charged and all the payments that were made to the facility was provided. Regarding the allegation: Staff did not allow visitors. During the investigation it was discovered Resident 1 (R1) and Resident 2 (R2) had two children involved in the care of the residents. One sibling lived out of state and another sibling was local. The local siblings would show up to the facility to visit a lot. When speaking to a family member of both residents, it was discovered staff never told the local sibling they could not visit the facility. The facility had conversations with the out of state siblings regarding the local sibling’s behavior when they would come to the facility and the possibly of that sibling clogging a shower drain in R1’s bedroom. However, it was discovered, staff never told the local sibling they could not come and visit, and the staff never told the sibling that was out of state that the local sibling could not come and visit the facility. Based on the information gathered through interviews and document review, the allegations are deemed unfounded, meaning the allegations are false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 9, 2026 · control 22-AS-20260717092250

Type of visit: POC

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility for the purpose of conducting a Plan of Correction inspection for a deficiency issued during the required annual inspection on March 11, 2026. LPA was greeted and granted entry by staff. LPA met with Health and Wellness director Sandra Arze and discussed the purpose of the visit. LPA reviewed staff documentation for Staff #1 and observed updated 20 hours of annual training has been conducted, thus fulfilling the Type B deficiency for CCR 1569.625(b)(2). During the visit LPA gathered documentation for a change of administrator for the facility. An exit interview was conducted and a copy of this report along with a letter of cleared deficiency was provided at the time of the visit.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrators (AD) Lea Wine and Christine Chon and discussed the purpose of the visit. The facility is a three story building with resident rooms on each floor, a memory care unit on the first floor, dining rooms, kitchen, laundry rooms, activity rooms, staff offices and outdoor seating areas. The facility appears clean, safe and sanitary. LPA observed all resident rooms to have the required components and furnishings. LPA observed the resident bathrooms to have paper towels, toilet paper and textured shower flooring. LPA tested the water in resident rooms on all three floors to be between 111.7-117.8 degrees Fahrenheit. LPA observed the kitchen to be clean and free of vermin. LPA observed the walk-in fridge and freezer to be at regulatory temperatures to maintain food quality. LPA observed a two day perishable and seven day non perishable food supply on hand. LPA observed the kitchen to have a lock when not in use making the knives inaccessible to residents in care. LPA and AD tested the delayed egress in the memory care unit and it was found to be operational. LPA and AD tested the signal system and had a 2 minute response while in the memory care unit as well as the assisted living side of the facility. LPA observed the memory care dining room to be free of any sharps. LPA observed the toxins and chemicals to be locked in a closet in the kitchen as well as a housekeeping closet on the 3rd floor and made inaccessible to residents in care. LPA observed a clean supply of linens in the laundry room on the 2nd floor for resident use. LPA observed the centrally stored medication to be in the wellness office located on the first floor locked in cabinets and medication carts and made inaccessible to residents in care. LPA observed a completed first aid kit in the medication room with all the required components. Continue on LIC809C LPA observed fire extinguishers throughout the facility charged and with a service date of February 13, 2026. LPA observed an outdoor shaded seating area in the memory care unit as well as the assisted living side of the facility that is free of obstructions and debris. LPA reviewed staff files and 1 of 5 staff do not have updated annual training. LPA reviewed resident files and 6 of 8 residents do not have updated needs and services plans. LPA reviewed resident medications and no discrepancies were observed. LPA reviewed that the last fire drill was conducted on January 19, 2026. LPA reviewed a fire alarm test from Hilltop Alarms Inc. stating that the fire alarms were tested on April 14, 2025 and passed. Based on todays inspection, deficiencies and a technical violation are being noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC809D, 858, 859, technical violation and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Mar 11, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Hanna Gough made an unannounced health and safety case management visit to follow up on a fax received by the Orange County Regional Office on September 30, 2025, stating that the facility will be adding central air conditioning to the facility hallways. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Darlene Lindley and discussed the purpose of the visit. LPA toured and inspected the facility and conducted health and safety checks on residents in care. LPA observed that the air conditioning installation is not impeding on residents care or taking up space in the resident hallways causing disruption with resident movement throughout the facility. Residents are allowed access to the hallways and can move around the facility as normal. LPA observed air conditioning technicians around the facility doing maintenance work and have informed AD that they are near completion. No health and safety concerns were observed. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 31, 2025

Allegation investigated: Staff do not allow residents to make decisions regarding their care Staff obtained hospice services on behalf of residents who do not meet the criteria for hospice care

Licensing Program Analyst (LPA) Hanna Gough made an unannounced inspection for the purpose of investigating the above allegations. LPA was greeted and granted entry by staff. LPA met with Care Coordinator (CC) Sandra Arze and spoke with Administrator (AD) Lea Wine over the phone. LPA discussed the purpose of the visit with CC and AD. The investigation into the allegation that staff do not allow residents to make decisions regarding their care and staff obtained hospice services on behalf of residents who do not meet criteria for hospice care pertaining to Sierra Hospice Care revealed the following: during the course of the investigation file review revealed there was only one resident receiving hospice care from Sierra Hospice Care at the time of the complaint. Upon file review LPA observed resident #1 (R1) being referred to Sierra Hospice by a medical doctor on September 30, 2024, and was evaluated for intake by a Sierra Hospice nurse. Continue on LIC9099-C Unfounded R1 was referred to hospice due to a diagnosis of cachexia. LPA obtained R1s physicians report that states that R1 was receiving hospice care due to cachexia with a date of September 30, 2024. LPA observed hospice intake papers signed by R1s responsible party. LPA observed R1s LIC625 Needs and Services Plan was updated on September 30, 2024, stating that R1 would be receiving hospice comfort care due to R1s diagnosis as part of their new care plan. The Needs and Services Plan was signed by R1s responsible party. Interviews with 3 of 3 staff stating that they do not evaluate, intake or assist with hospice care plans. 3 of 3 staff informed LPA that they will give families information on different hospice programs and nothing more. Interviews with 9 of 9 residents in care stated that they go to the day care by choice and if they decide not to go the facility staff do not force them, it is entirely their decision. LPA interviewed staff and 3 of 3 staff stated that if a resident declines to go, the facility staff honors their choices and makes note of it so they know who was left at the facility. Interview with day care staff informed LPA that they have not heard any complaints from the residents. Based upon LPAs observations, interviews and information gathered during the investigation and review of all documents obtained, the preponderance of evidence standard has not been met, therefore the above allegations are deemed UNFOUNDED. Meaning that the allegations staff do not allow residents to make decisions regarding their care and staff obtained hospice services on behalf of residents who do not meet the criteria for hospice care was false, could not have happened and/or is without a reasonable basis. The department therefore dismissed the complaint. An exit interview was conducted with CC Sandra Arze and AD Lea Wine and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 20, 2025 · control 22-AS-20241105125907

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility for the purpose of a case management inspection. LPA was greeted and granted entry by staff. LPA me with Administrator (AD) Darlene Lindley and Lea Wine and explained the reason for the visit. The Orange County Regional Office received a letter on April 14, 2025 stating that the facility will be replacing the carpet on the second and third floor hallways with wood flooring and that this project should be completed on April 29, 2025. LPA toured the facility to ensure that the renovations were completed and that the health and safety of the residents were upheld during the renovations. LPA observed the new wood flooring and AD explained that they did half of the hallway at a time to ensure the residents could get to and from their rooms. AD explained to LPA that residents were escorted out of their rooms if they required extra assistance. Based on observations during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Darlene Lindley and Lea Wine and a copy of this report was given at the time of inspection.the state’s words, verbatim · CDSS document, May 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) William Vanegas made an unannounced inspection for the purposes of an annual inspection. Upon arrival LPA Vanegas was greeted by front desk receptionist, and met with Administrator (AD) Darlene Lindley and Assistant AD Lea Wine. LPA Vanegas explained reason for the inspection, began a tour of the facility, and observed the following. This is a three storied residential care for the elderly facility with a memory care unit. Facility is operating within the conditions and limitations specified on the license. LPA Vanegas observed the facility to be clean, sanitary, and free of any debris, insects, and rodents through out the property. LPA Vanegas observed all common areas including; lobby, dinning area in assisted living unit, and dining area in memory care unit. LPA inspected resident bedrooms and observed all resident bedrooms to have required furnishings such as lamps, chairs, beds, chest drawers, enough storage space for personal belongings, and linens in good repair, meaning no strains or tears. LPA Vanegas observed resident bathrooms to be clean and free of mildew, water faucets and toilets tested to be operational. Resident bathrooms had all required furnishings such as a shower chair, grab bars, and slip resistant matts. Water tested between 118.4 and 121.4 degrees. LPA Vanegas observed all toxins, sharps, and medications to be locked away and inaccessible to residents in care. LPA Vanegas observed a two day supply of perishable food, and a seven day supply of non-perishable food sufficient enough for all residents in care and on duty staff. LPA Vanegas also observed enough emergency water on hand for residents in care, and staff on duty. LPA Vanegas observed the outside of the facility and there were no obstructions a long the exit routes or blocking the exit doors. There are two courtyards, one in the memory care unit, and one in the assisted living unit. They are both big enough to participate in outdoor activities upon resident request. CONTINUED ON LIC809C LPA Vanegas reviewed five resident files, and five staff files all files (Staff and Resident) Consisted of all required documentation. All staff annual training is up to date, and documented. LPA Vanegas observed all fire extinguishers in common areas, and kitchen area to be fully charged and up to date. LPA Vanegas observed fire alarm testing that has been documented it is up to date, and smoke and carbon monoxide detectors tested operational. LPA Vanegas reviewed resident medication with AD, and Medical Technician on duty, Per LPA Vanegas review medications are not being documented correctly when administered to resident's in care. LPA Vanegas observed and up to date infection control plan, and a disaster preparedness plan. Both documents were observed to have been reviewed by staff, and are fully documented. Based on observations made during today's inspection deficiencies will be cited per tittle 22 chapter 8 division 6 of the California Code Of Regulations. An exit interview was conducted with AD Darlene Lindley and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 11, 2025

Allegation investigated: Staff did not meet the resident's needs.

This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and Hanna Gough for the purpose of investigating the above-mentioned complaint allegation. LPAs met with Administrator (AD) Darlene Lindley, discussed the purpose of the inspection, and explained the allegation. The investigation into the allegation that staff did not meet the resident's needs revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed AD, residents, staff, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Skilled Nursing Facility Discharge Paperwork dated June 6, 2024, R1’s Orientation/In-Service Training dated June 7, 2024, a facility incident report dated June 10, 2024, R1’s Preplacement Appraisal dated June 6, 2024, R1’s Appraisal dated June 6, 2024, R1’s Appraisal/Needs and Services Plan dated June 6, 2024, a facility incident report dated October 5, 2024, R1’s Preplacement Appraisal dated January 18, 2025, R1’s Appraisal/Needs and Services Plan dated January 18, 2025, a facility incident report dated January 20, 2025, and the facility’s Memory Care Headcount Logs. Unsubstantiated It was alleged that R1 had three falls since July 2024, R1 is often left alone at the facility, and staff ignore R1’s toileting needs. LPAs inspected the facility, conducted health and safety checks on residents present, and observed no health and safety issues. LPAs inspected R1’s room, noted R1 is not currently present at the facility, and observed a hospital bed with a half bedrail, a fall mat, and a walker in R1’s room. LPAs interviewed AD who stated R1 moved in on June 6, 2024, and was noted as a fall risk. LPAs reviewed R1’s Skilled Nursing Facility Discharge Paperwork dated June 6, 2024, which states R1 has a history of falls and fractures, and requires assistance with mobility, transfers, and toileting. LPAs reviewed R1’s Orientation/In-Service Training dated June 7, 2024, which indicates the facility had a fall prevention plan and staff were trained on how to meet R1’s needs. However, despite the fall prevention plan, per AD, shortly after moving in, R1 had their first fall. LPAs reviewed a facility incident report dated June 10, 2024, which states R1 had an unwitnessed fall on June 7, 2024, which resulted in a wrist sprain. After this fall, R1’s fall prevention plan was updated. LPAs reviewed R1’s Preplacement Appraisal dated June 6, 2024, R1’s Appraisal dated June 6, 2024, and R1’s Appraisal/Needs and Services Plan dated June 6, 2024, which document R1’s fall prevention plan was updated to include a hospital bed with half bed rails, bed alarms, a walker, and checks every 15 minutes. Per AD, after these fall prevention precautions were put in place, R1 did not have another fall until October 5, 2024. LPAs reviewed a facility incident report dated October 5, 2024, which states that on October 5, 2024, R1 was found on the floor and taken to the hospital. Per AD, R1 was diagnosed with a hip fracture as a result of this fall, was treated at a hospital, and continued treatment at a skilled nursing facility until January 17, 2025. Per AD, R1 was brought back to the facility on January 18, 2025, with updated fall precautions. LPAs reviewed R1’s Preplacement Appraisal dated January 18, 2025, and R1’s Appraisal/Needs and Services Plan dated January 18, 2025, which document that R1’s fall prevention plan was updated to include bed-to-chair standby assist. However, per AD, R1 had another fall shortly after returning to the facility. LPAs reviewed a facility incident report dated January 20, 2025, which states that R1 had a witnessed and assisted fall on January 19, 2025 and sent to the hospital. Per AD, R1 was released from the hospital, is not currently at the facility, and the facility will reassess whether it can meet R1’s needs. Per AD and staff interviews, memory care residents are checked on every 15 minutes. LPAs reviewed the facility’s Memory Care Headcount Logs which corroborate that memory care residents are checked on every 15 minutes. Per witness interviews, there are no concerns regarding the fall prevention plan put in place by the facility. LPAs interviewed AD and three staff who denied that R1 was left alone or that R1’s toileting needs were ignored. LPAs interviewed one witness who did not corroborate the allegation. LPAs interviewed seven residents who did not corroborate the allegation. Although R1 had falls on June 7, 2024, and October 5, 2024, the facility had a proper fall prevention plan in place which it updated in response to R1’s falls in order to address R1’s fall risk and the fall on January 19, 2025, was witnessed and assisted, which means it could not have been prevented by the fall prevention plan. The information obtained did not corroborate the allegation. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jan 24, 2025 · control 22-AS-20250121100704

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Dwayne Mason Jr. conducted this unannounced Case Management visit on today’s date. LPA arrived at facility was greeted and granted entry by staff. Nadia Chavelas. LPA met with Administrator (AD) Darlene Lindley and Assistant Administrator (AAD) Lea Wine. LPA explained the purpose of the inspection. LPA stated that Community Care Licensing received an incident report from the facility on 6/6/2024 stating that a resident left the facility unassisted on 6/5/2024. LPA reviewed the resident's Physician's Report. Based on record review, the Physician's Report indicates that the resident is unable to leave the facility unassisted. Based on the incident report and interview with Administrator, LPA determined that the resident left the facility unassisted. A deficiency is being issued on this day. Based on Title 22, Dvision 6 of the California Code of Regulations, one deficiency is being issued. LPA reviewed this report with AD and AAD and provided this report, deficiency page and appeal rights to the facility.the state’s words, verbatim · CDSS document, Jun 21, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(k)(4) · Plan of correction due date: Jul 5, 2024

87705(k)(4)CARE OF PERSONS WITH DEMENTIA (4) Without violating Section 87468, Personal Rights, facility staff shall attempt to redirect a resident who attempts to leave the facility. Based on incident report submitted to licensing and interview with Administrator the facility did not comply with the section cited above due to the fact that one dementia resident left the facility unsupervised.the state’s words, verbatim · CDSS document, Jun 21, 2024

Plan of correction: AD stated that they will conduct in-service training with facility staff to ensure staff understands how to properly supervise dementia residents. AD stated that, by the POC due date, they will email LPA documentation indicating the attendees, date(s) of the training and topics covered.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection to follow up on corrections identified during visit on 2/12/2024. LPA met with designated Administrator (AD) Young Park, Executive Director (ED) Darlene Lindley, Assistant Administrator Lea Wine, and Corporate Member Yung Lee. An application to operate a Residential Care Facility for the elderly (RCFE) for (210) capacity, (38) ambulatory, (147) non-ambulatory, and (25) bedridden residents was received by CCL on 7/20/2023. At 1:15 p.m. LPA toured the facility and observed the following: Renovations in resident bedrooms, 118,124,128, 129, 130, 131, 137,138, and 139 have ceased. Water temperature in resident bathrooms 247 and 248 has been adjusted to meet regulation, and tested at 107.6 degree F. Ceiling tiles in the second story are in place and the gap which was visible in the ceiling exposing wood beams has been repaired and is no longer visible. All four guinea pigs observed to be living in a staff office on the second story have been removed and the staff office is now odor free. Component III: was conducted during this inspection, information provided about how to operate the facility within compliance and reporting requirements. The facility is ready to be licensed. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 22, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Claudia Gutierrez made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with designated Administrator (AD) Young Park, Executive Director (ED) Darlene Lindley, Assistant Administrator Lea Wine, and Corporate Member Yung Lee. An application to operate a Residential Care Facility for the elderly (RCFE) for (210) capacity, (38) ambulatory, (147) non-ambulatory, and (25) bedridden residents was received by CCL on 7/20/2023. Structure: The facility is a three-story building. The first story consists of the lobby, two staff offices, one medication room, one kitchen, one dining room, and 10 resident bedrooms on the assisted living side. Memory care is also located on the first floor and consists of 30 resident bedrooms, one living room, two communal rooms, one dining room, one medication room, two storage closets, one laundry room, and an enclosed courtyard. Delayed egress was tested and observed to be operable. The second story of the facility consists of one activity room, one staff office, two storage closets, one theater room, one library, and 49 resident bedrooms. The third story consists of one family room, one dining area, one hair salon, two janitors’ closets, one storage closet, one laundry room, and 20 resident bedrooms. All resident bedrooms also contain their own full-size bathroom. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the lobby. There are two courtyards, one is located within memory care and an additional courtyard is on the assisted living side of the facility. There is a shaded seating area and LPA did not observe any obstacles or hazards in the courtyard. Resident Bedrooms Occupied resident bedrooms had the required furnishings and LPA observed beds had linens and blankets. Signal system There is signal system. Signal system was tested and observed to be operable. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and locked in the various storage closets located throughout the facility. Medications, First-Aid Kit & Book: Medication will be stored in the medication room. First aid kit is stored with medication. The first aid kit has all the required elements. Resident & Staff Files: Records will be kept locked in a staff office. Pool/Jacuzzi: No bodies of water were observed. Fire Extinguisher: Fire extinguishers were observed on every floor of the facility and were fully charged with a service tag dated 2/17/24. Reading Material, Games, Equipment & Materials: The facility has card games, puzzles, and other recreational materials for the client’s use, stored in the activity room. Fire clearance: Was approved by a fire inspector of Anaheim Fire Department on 01/05/2024. Special conditions noted, “Bedridden on first floor only.” Bedrooms Staff: There are no staff bedrooms. Smoke Detectors: Smoke detectors and carbon monoxide detectors tested operational. Bathrooms: All bathrooms have working plumbing. Hot water temperature was tested in five resident bedrooms on the first floor, including memory care and tested between 109.7- and 119.1-degrees Fahrenheit. Hot water temperature was tested in five resident bedrooms on the second story and tested between 93.5-117.1 degrees Fahrenheit. Hot water temperature was tested in two resident bedrooms on the third story and tested between 109.4-120.4 degrees Fahrenheit. Emergency Phone Numbers, Exit Plan & Menu: Posted and available, means of exiting, and emergency phone numbers. Food menu is available for review. Food Service: A supply of 2-day perishable and 7-day of non-perishable food was observed and will be maintained on hand. Appliances: Appliance were inspected and observed to be operational. Licensee to address the following corrections by 02/26/2024: Renovations were observed to be taking place in resident bedrooms, 118,124,128, 129, 130, 131, 137,138, and 139. Water temperatures tested at 93.5 degrees F in resident bathrooms 247 and 248. Water temperature to be adjusted to meet regulation of 105 to 120 degrees F. Ceiling tiles in the second story have been moved or are missing and a gap is visible in the ceiling exposing wood beams and covered by a thin clear plastic sheet. Four guinea pigs are currently living in a staff office on the second story. Two out of the four guinea pigs were observed to be in a designated guinea pig cage. Two out of four guinea pigs are currently being kept in a collapsible wagon intended for hauling. LPA will make an additional announced visit to follow-up on corrections listed above. An exit interview was conducted, and a copy of this report was provided to designated AD.the state’s words, verbatim · CDSS document, Feb 12, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Facility Type: RCFE Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. 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 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 6. Physical plant, food service 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 propertythe state’s words, verbatim · CDSS document, Dec 20, 2023

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. 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 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 6. Physical plant, food service 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 propertythe state’s words, verbatim · CDSS document, Dec 19, 2023