New World Villa South

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced Case Management visit to cite deficiencies identified during a Plan of Correction (POC) visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with caregivers Mariaelena Bautista and Victoria Bayani. During the visit, LPA reviewed facility files which revealed Staff #1 (S1) did not include criminal record clearance. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] A review of the Department's Guardian background check system revealed S1 has eligible background clearance, but is not associated to the facility. Per S1, they started working at the facility on 9/10/26. One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 809 D page) and a Civil Penalty is being assessed for the total of $500 (refer to attached LIC 421BG). A Plan of Correction was jointly developed with Victoria Bayani. An exit interview was conducted with Caregiver Victoria Bayani, to whom a copy of this report, the LIC 809 D, LIC 421BG, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 14, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Sep 15, 2026

87355 Criminal Record Clearance(e) All individuals subject to a criminal record review ...shall prior to working...: (3) Request a transfer of a criminal record clearance... This requirement is not met as evidenced by: LPA record review revealed S1's criminal record clearance was not transferred to the facility prior to working at the facility. This poses an immediate health and safety risk to 4 of 4 residents in care.the state’s words, verbatim · CDSS document, Sep 14, 2026

Plan of correction: Facility staff will request transfer of S1's clearance to the facility on Guardian and submit proof to LPA by POC due date.

Type of visit: POC

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to conduct a Plan of Correction (POC) visit to confirm that citations which were issued on 9/3/26, have been corrected. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with caregivers Mariaelena Bautista and Victoria Bayani. The following citations were reviewed during today's visit: 87303(e)(2) Maintenance and Operation: LPA measured water temperatures accessible to residents and were recorded at the following degrees in Fahrenheit: 109.9, 110.8, 110.3, 110.7. 87506(c)(1) Resident Records: LPA observed confidential records stored in locked areas. 87412(a)(11), 87412(a)(13)(A) Personnel Records and 87411(c)(1) Personnel Requirements: LPA reviewed required staff records which were previously missing including the Health Screening Report, Criminal Record Statement, and updated first aid training. 87465(i) Incidental Medical and Dental Care: LPA observed destruction of medications of deceased resident. All POCs due today, 9/14/26, have been cleared. An exit interview was conducted with Caregiver Victoria Bayani, to whom a copy of this report, the letters of deficiency citations cleared, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 14, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Angelica Boyles and Patrice Bazemore conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Victoria Bayani and Caregiver Florencia Pangilinan. LPAs also spoke with Administrator Shamila Yasar over the phone. LPAs, accompanied by caregiver, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperatures in bathrooms accessible to residents were recorded at the following temperatures in Fahrenheit: 128.8, 125.0, 140.0, 146.5. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. LPAs observed medications not stored in original packaging as well as medications that were not destroyed upon a resident's death on 8/31/26. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC 809) No pools or bodies of water were observed on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs reviewed multiple staff and resident records/files. Staff files reviewed did not contain required documents. Confidential records were not stored in locked areas. Proof of current/active business liability insurance was presented. Seven deficiencies and one Technical Violation were observed during today's visit per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages and LIC9102). A plan of correction was jointly developed with Administrator. An exit interview was conducted with Administrator Shamila over the phone and Caregiver Flor signed for. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Sep 14, 2026

Maintenance and Operation (e) Water supplies...shall be maintained as follows: (2) Faucets used by residents...shall deliver hot water. Hot water temperature controls shall...attain a temperature of not less than 105 degree F...and not more than 120 degree F... This requirement was not met as evidenced by: LPAs measured sinks accessible to residents at the following temperatures: 128.8, 125.0, 140.0, and 146.5. This poses an immediate health and safety risk to 2 of 2 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Facility staff agreed to adjust the water heater temperature by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(c)(1) · Plan of correction due date: Sep 14, 2026

Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing ...records and for safeguarding the confidentiality of their contents... This requirement was not met as evidenced by: LPAs observed records being stored in cabinets without being locked. This poses a potential personal rights violation to 2 of 2 redients in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Facility staff agreed to put a lock on the cabinets by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Sep 30, 2026

Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: LPAs observed medications being stored in weekly medication dispenser. This poses a potential health and safety risk to 2 of 2 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Facility staff agreed to stop pre-dispensing medications and staff will complete medication training by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(i) · Plan of correction due date: Sep 14, 2026

Incidental Medical and Dental Care(i) Prescription medications which are not taken with the resident upon termination of services...nor disposed of according to the hospice’s established procedures...shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years... This requiement was not met as evidenced by: LPAs observed medication being centrally stored from R1, who passed away on 8/31/26.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Facility staff agreed to complete a destruction record of R1's medication by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a)(11) · Plan of correction due date: Sep 14, 2026

Personnel Records (a) The licensee shall ensure that personnel records are maintained on...each employee. Each personnel record shall contain the following information: (11)A health screening... This requirement was not met as evidenced by: Per records reviewed, S1 did not have a Health Screening form on file. This poses a potential health and safety risk to 2 of 2 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Facility staff agreed that S1 would have a completed Health Screening report by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a)(13)(A) · Plan of correction due date: Sep 14, 2026

Personnel Records (a) The licensee shall ensure that personnel records are maintained on...each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted... (A) A signed statement regarding their criminal record history... This requirement was not met as evidenced by: Per records reviewed, S2 did not have a signed Criminal Record Statement. This poses a potential health and safety risk to 2 of 2 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Facility staff agreed to have S2 complete a LIC508 Criminal Record Statement by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c)(1) · Plan of correction due date: Sep 14, 2026

Personnel Requirements – General (c) All RCFE staff who assist residents...shall receive ...annual training as specified... (1)Staff providing care shall receive appropriate training in first aid from persons qualified... This requirement was not met as evidenced by: Per records reviewed, S2 and S3 did not have up to date first aid training. This poses a potential health and safety risk to 2 of 2 residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Facility staff agreed to have S2 and S3 complete updated first aid training by POC due date.

Allegation investigated: False statements Licensee did not follow reporting requirements

Licensing Program Analyst (LPA) Kennedy conducted an unannounced visit to conclude a complaint investigation. Upon arrival, LPA was greeted by Vicky Bayani, identified herself, and was granted entry into the facility. LPA met with Vicky Bayani, to whom the purpose of the visit was explained. The Department’s investigation included staff and outside source interviews, as well as a review of facility and external records. On November 6, 2025, the Department received a complaint alleging that the Licensee made false statements and failed to meet reporting requirements. These allegations stemmed from a prior complaint received on October 29, 2025, which alleged thefts committed by Staff 1 (S1) involving Resident 1 (R1), Staff 2 (S2), Staff 3 (S3), and facility belongings. Substantiated The complaint filed on October 29, 2025, was investigated and determined to be substantiated. As a result, the Department issued a lifetime exclusion prohibiting S1 from employment at any state licensed facility. During the October 29, 2025, complaint investigation, interviews and record reviews indicated that the Administrator (ADM) and Licensee were aware of thefts committed by S1. An interview with S2 revealed that staff had noticed missing belongings, including jewelry belonging to R1 and S3. S2 also reported their personal credit card had gone missing. Interviews with S2 and Staff 4 (S4), along with corroborating records, confirmed that the ADM and Licensee had knowledge of the thefts, which were not reported to the Department. Record reviews included written communication from the ADM directing S1 to return stolen items. These items were subsequently returned to the facility and to the rightful owners. Records dated November 6, 2025, documented the Licensee sending a message to the ADM regarding the identification number (IMEI) of the stolen facility phone to confirm that the phone returned by the individual who purchased it from S1 was, in fact, the phone that belonged to the facility. In the same communication, the Licensee informed the ADM that the phone “did not matter anymore” because both the phone and the phone number had been removed from their records. Additionally, during a collateral visit conducted on November 6, 2025, S4 corroborated that the Licensee had knowledge of S1’s thefts. On August 28, 2025, the Department conducted an unannounced facility visit and subsequently held an office meeting with the Licensee and S4 at the San Diego Regional Office (SDRO). During the meeting, the Licensee was questioned regarding the Change of Ownership (CHOW) application received by the Department on 9-8-25. When asked whether they had followed CHOW procedures and protocols required by state mandate, the Licensee stated they were unaware of the requirements. On December 17, 2025, the Department received a letter from the Licensee stating they had no knowledge of any thefts and that they had relinquished ownership of the facility to the ADM in May 2025. During a collateral interview, S4 reported receiving a phone call from the Department in June 2025 regarding the CHOW application submitted by the Licensee. S4 stated they had no prior knowledge that the Licensee had submitted the application in May 2025. S4 also stated that immediately after receiving the Department’s notification, they discussed CHOW requirements with the Licensee, outlined the mandated steps, and asked the Licensee whether they had complied. This included verifying whether the Licensee had issued written notification to residents and/or Responsible Parties (RPs) and the Department regarding the intent to sell the facility. Subsequently, on June 26, 2026, the Department received an email from the Licensee disclosing the facility will be undergoing a CHOW that will go into effect in 60 days. An interview with Outside Source 1 (OS1) further revealed that the Licensee had previously been informed of CHOW procedures and requirements when they acquired two facilities via CHOW in May 2021. This information contradicts the Licensee’s statement made during the August 28, 2025, office meeting, claiming they were unaware of CHOW requirements. Per Title 22, California Code of Regulations (CCR), Division 6, Chapter 8, Section 87109, the Licensee is required to comply with the provisions of Health and Safety (H&S) Code 1569.191, which establishes requirements for the sale or transfer of a licensed Residential Care Facility for the Elderly (RCFE). H&S Code 1569.191 requires a Licensee intending to sell or transfer the facility property or business must provide written notice to the Department and to each resident or their legal representative at least 30 days prior to the transfer, or at the time a bona fide offer is made, whichever period is longer. Any resident admitted after the notification period must also be informed in writing of the Licensee’s intent to sell or transfer the facility prior to signing an admission agreement. The Licensee is also required to ensure that a copy of the written notice is sent to the licensing agency. An interview with Resident1 (R1) confirmed that they had no knowledge of the Licensee and believed the ADM was the owner (Licensee) of the facility. An interview with the ADM disclosed no knowledge of the Licensee providing any notification to staff, residents, or their RPs. The ADM reported that they personally sent text message notifications to residents’ RPs stating that they were the new owner. These notifications were sent months after the CHOW application had been submitted to the Department and after the ADM’s purchase of the facility. On January 9, 2026, the Department emailed a request to the Licensee for copies of the required written notifications provided to each resident or their Responsible Party (RP), as mandated by state regulations. The Department did not receive a response. A review of facility records revealed that the CHOW application submitted to the Department has not been approved to date. Therefore, the Licensee remains the legal owner and is still the responsible party for the facility. Based on interviews and records reviews, the Department determined the above-mentioned allegations to be substantiated. A substantiated finding means that the preponderance of evidence standard was met, indicating that the allegations are valid. An exit interview was conducted withVicky Bayani. A copy of this report, along with LIC 9099D and Appeal Rights (LIC 9058), was provided. Signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, May 11, 2026 · control 08-AS-20251106144027

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87207 · Plan of correction due date: May 25, 2026

No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidenced by: Based on Staff and Outside Source interviews the Licensee statement to the Department that they lacked knowledge regarding the mandated requirements with a change of ownership was falsified. This posed a potential personal rights risk to # of # residents in care.the state’s words, verbatim · CDSS document, May 11, 2026

Plan of correction: Adninistrator will review the regulations cited and send a letter to CCL acknowledging understanding and expressing a commitment to follow the regulation by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 25, 2026

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.This requirement was not met as evidenced by: Based on interviews and record reviews. Based on staff interviews and record reviews, the Licensee did not report the theft of a resident’s (R1) personal belongings by Staff 1 (S1) to the Department This posed a potential personal rights risk to # of # residents in care.the state’s words, verbatim · CDSS document, May 11, 2026

Plan of correction: Adninistrator will review the regulations cited and send a letter to CCL acknowledging understanding and expressing a commitment to follow the regulation by POC date.

Allegation investigated: Resident sustained an injury due to lack of supervision

On 4/21/2026, LPA Grace Donato conducted a telephone interview with the facility to deliver findings. LPA spoke with Zayden Chen and explained the purpose of the call. For the allegation of resident sustained an injury due to lack of supervision, reporting party (RP) stated that a resident (R1), had fallen down on the floor in two consecutive days. On the second incident, R1 sustained head injury and was sent to hospital. On 10/22/2024, R1 had a mechanical fall injury. R1 accidentally tripped and fell while using the bathroom sustaining a one-inch laceration on the head. Facility staff (S1) called 911, paramedics arrived and R1 was sent to hospital. An unusual incident/injury report was made to Community Care Licensing (CCL). page 1 of 2 Unsubstantiated R1s family member (F1) stated that F1 took R1 to hospital on 10/21/2024, for an evaluation of shortness of breath. R1 had no respiratory distress and was not admitted as there was no evidence or respiratory distress at that time, therefore there was no unusual incident/injury report made to CCL. Based on the corroborating evidence and statements made by staff and family there is no evidence to show neglect/lack of care of supervision resulting in serious bodily injury or delayed medical care of R1. Based on interviews, observations and records review, the department has determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Report is reviewed and copy is provided. page 2 of 2the state’s words, verbatim · CDSS document, Apr 21, 2026 · control 08-AS-20250220113308

Allegation investigated: Personal Rights Licensee did not address theft

Licensing Program Analyst (LPA) Correia conducted an unannounced visit to conclude a complaint investigation. Upon arrival, LPA was greeted by Caregiver Bayani, identified herself, was granted entry into the facility, and explained the purpose of the visit. The Department’s investigation included interviews with staff and outside sources, as well as a review of facility and external records. On October 29, 2025, the Department received a complaint alleging theft by a staff member (S1) involving a resident (R1) and the facility’s dedicated iPhone. It was further alleged that the facility Administrator (ADM) and Licensee were aware of the thefts but failed to take sufficient action to address the ongoing abuse. [Continued of LIC 9099C] Substantiated [Continuation of LIC 9099] On November 5, 2025, the Department visited the facility and interviewed R1, who stated that the incident occurred approximately two months earlier. According to R1, the bracelet had been placed on a nightstand next to their recliner at approximately 9:00 p.m., but the following morning it was missing. R1 believed the bracelet had been taken and later returned four days afterward by S1. The Department subsequently interviewed S1, who acknowledged awareness of both the missing bracelet and the missing facility phone but denied involvement in the disappearance of either item. S1 also claimed not to know how the items were eventually located. The Department interviewed three additional staff members (S2, S3, and S4) who were working during the period of the alleged thefts. S2 and S3 reported that items began disappearing after S1 was hired. S2 believed the facility’s iPhone had been taken by S1, as S1 was the only staff member on shift when the phone went missing. Staff also reported other missing items, including jewelry and debit cards, following shifts worked by S1. S4 disclosed that they personally observed the facility’s red iPhone at S1’s residence and believed it had been given to S1’s landlord (OS1) as payment for past-due rent. OS1 was interviewed and confirmed that S1 had provided them with a red phone as collateral. The phone was later given to S4, who returned it to the facility. OS1 also reported that S1 was subsequently evicted for being two months behind on rent. On November 5, 2025, the Department interviewed ADM, who admitted being aware of the thefts. ADM stated that after learning of the missing items, they informed all staff that if the facility phone and jewelry were not returned by October 21, 2025, law enforcement would be contacted. ADM reported that on October 20, 2025, S1 called and confessed to taking R1’s bracelet. ADM met S1 in a public location to retrieve the bracelet and returned it to R1. S4 also located and retrieved the missing phone from S1’s landlord. It should be noted that the phone had been reported missing two months before S4’s employment began. [Continued on LIC 9099C] [Continuation of LIC 9099C] Upon being notified of the Department’s investigation on November 5, 2025, ADM sent S1 a text message notifying them of termination. On November 6, 2025, the Department received screenshots of text messages between ADM and facility staff confirming ADM’s awareness of the thefts and the ultimatum given to staff to come forward. During ADM’s interview, they explained that they were new to the business and unfamiliar with all regulatory requirements. ADM stated they attempted to give S1 a second chance based on personal cultural values. ADM assumed operational responsibilities in May 2025 after negotiating a contract with the Licensee. A review of facility records confirmed that an application for Change of Ownership (CHOW) was submitted on September 19, 2025, but had not yet been approved. Therefore, the Licensee remained the legal owner and responsible for the facility’s compliance with all applicable laws and regulations. On December 16, 2025, the Department interviewed the Licensee (LIC), who stated that the business had been sold to ADM in May 2025, at which time “day-to-day operational control” was transferred. LIC acknowledged being the “licensee of record” but denied any knowledge of S1 or the thefts. A review of records obtained on November 6, 2025, included a private text message exchange between ADM and LIC containing screenshots of a red phone. ADM asked, “Is this the phone?” LIC responded, “It doesn’t matter to me anymore. That phone and phone number is off our account.” LIC then provided an IMEI number, which indicated a match for the IMEI of the facility’s stolen phone. [Continued on LIC 9099C] [Continuation of LIC 9099C] Based on interviews and records reviewed, a preponderance of evidence indicates that on or before October 20, 2025, S1 committed thefts within the facility, including stealing a resident’s $2,000 bracelet and the facility’s iPhone. Interviews with ADM and staff (S2–S4), along with record review, further corroborated that facility management was aware of the thefts as of October 20, 2025. Per Health & Safety Code §1569.153, reports are to be made to local law enforcement within 36 hours when the administrator of the facility has reason to believe resident property with a then current value of one hundred dollars ($ 100) or more has been stolen. Despite this, ADM did not meet mandated reporting requirements or take action to protect residents until being notified of the Department’s investigation on November 5, 2025, at which point ADM sent S1 a text message to terminate their employment. On November 7, 2025, the Department issued and served an immediate exclusion order prohibiting S1’s employment or presence in any state-licensed facility or Home Care Organization (HCO). [See LIC 811 for Confidential Names] Based on observation, interview and record review, the preponderance of evidence standard has been met and both allegations are substantiated. Deficiencies were cited in accordance with Chapter 8, Division 6 of the California Code of Regulations and are listed on the attached LIC 9099(d). An exit interview was conducted with Caregiver Bayani. A copy of this report, along with the LIC 9099(d) and Licensee Appeal Rights (LIC 9058) was provided to Caregiver Bayani and emailed to Licensee at the conclusion of the visit. Signature below confirms receipt.the state’s words, verbatim · CDSS document, Mar 4, 2026 · control 08-AS-20251029155337

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Mar 5, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation…and abuse. This Requirement was not met as evidenced by: Based on record review and interview, one staff member (S1) took a resident’s bracelet valued at $2,000. This posed an immediate personal rights risk to 1 of 5 (R1) residents in care.the state’s words, verbatim · CDSS document, Mar 4, 2026

Plan of correction: Per the Administrator (ADM) and the Department's investigation The ADM terminated S1 on November 5, 2025. Deficiency Is cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(25) · Plan of correction due date: Mar 5, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition ...residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (25) To protection of their property from theft or loss according to Health and Safety Code sections 1569.152,1569.153, and 1569.154. This requirement was not met as evidenced by: Based on record review and interview, the licensee did not file a law enforcement report within 36 hours of learning that care staff (S1) stole a $2,000 bracelet from a resident (R1). This posed an immediate personal rights risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Mar 4, 2026

Plan of correction: The ADM revealed they attended a CCL approved training regarding Personal Rights post initiation of the investigation. The Licensee and care staff are in process of attendance. Certificate of completion will be provided by the POC due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Janet Ngallo and Angelica Boyles conducted an unannounced Case Management visit to the facility. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Josefina Pilapil. Administrator Shamila Yasar was contacted via phone regarding the visit. On today's date, LPAs delivered an Immediate Exclusion letter for Staff 1. Administrator Yasar stated they understood the reason for its issuance. No deficiencies were cited during the visit. An exit interview was conducted with Administrator Shamila Yasar via phone. A copy of this report, the Immediate Exclusion Letter for S1, and the Licensee/Appeal Rights (LIC 9058) were provided to caregiver Josefina Pilapil. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Nov 7, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) made an unannounced visit to the facility to deliver deficiencies identified through the comprehensive annual licensing inspection that commenced on September 15, 2025. LPA identified themselves to Med-Tech Bartolome and was granted entry into the facility. The facility is licensed to serve six (6) residents; of which all of whom may be non-ambulatory and/or receiving Hospice Services, and 1 resident may be bedridden. The facility’s current census is five (5) residents, and all 5 residents were present. During today’s visit LPA conducted a brief facility tour and rendered deficiencies for four (4) violations, identified by a prior visit for the continuation of the annual inspection. In addition, LPA in collaboration with Med-Tech Bartolome created plans of corrections Deficiencies were cited during today's visit and are listed on the LIC 809D pages. A copy of the LIC 809 and deficiencies LIC 809D, and the License Appeal Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an additional continuation of the comprehensive required annual inspection that commenced on September 15, 2025. LPA identified herself to Med Tech Allan Bartalome (S1) and was granted entry into the facility. Staff Yasar (S2) later arrived at the facility and joined the inspection. A review of staff records revealed there was no documentation on staff training, and an interview with S2, S1, and S3 confirmed staff had not received the required training prior to their starting date. The records review also revealed two (2) of the staff members were missing additional required records on file. An interview with S2 and a facility records review also showed staff had never participated in a disaster drill, could not provide an infection control plan, nor provide current liability insurance. LPA, accompanied by S1, inspected the facility kitchen. LPA observed the facility kitchen to be unsanitary, including dead pests in the kitchen cabinets/drawers, and in need of deep cleaning. The inspection did reveal the facility had an adequate amount of food, that included a 2-day supply of perishable and 7-day supply of non-perishable food, and sharps (e.g., knives) were observed stored in a locked cabinet. LPA also observed all essential dishware and utensils needed for cooking and eating. In addition, the facility was equipped with smoke and carbon monoxide detectors, and fire extinguishers, that were all operable and/or up to date. A review of the resident Medication Administration Records (MARs) revealed Resident1 (R1) ran out of their daily heart medication on approximately July 15, 2025, and had not received a refill since, in addition, Resident 2 (R2), was going on the second day of missing their medication also due to running out and not receiving a refill. LPA observed the medications were stored in a locked medication cart, and medications that required refrigeration, were locked in a mini refrigerator. LPA observed resident rooms and bathrooms to be equipped with the required furnishings and safety equipment. Water at taps used by residents measured in compliance with regulation. The facility has a large common area and outdoor shaded area for residents’ activities and visitation. Required licensing postings were in visible areas of the facility. No pools or bodies of water were on the premises. Per S2 there are no firearms or ammunition kept at the facility. LPA concluded the required annual inspection during today’s visit, however, will be returning to issue citations for the above-described violations. An exit interview was conducted with Staff Yasar (S2) to whom copies of this report and the Licensee/Appeal Rights (LIC9058 03/22) will be provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 1, 2025

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct a continuation of the annual licensing inspection that commenced on September 15, 2025. LPA identified herself to Caregiver April Magat and was granted entry into the facility. Administrator Yasar was contacted and arrived at the facility to join the inspection. The facility is licensed to serve six (6) residents; of which all 6 may be non-ambulatory and/or receiving Hospice Services, and 1 resident may be bedridden. The facility’s current census is five (5) residents, and all 5 residents were present. During today’s visit LPA Correia conducted a staff records review and conducted a partial facility tour. A resident records review was conducted on September 15, 2025. An overall inspection of the facility continued today, however due to time constraints LPA was unable to complete the visit and will return later to conduct the remaining portion of this inspection. No deficiencies were cited during today's visit. This report was discussed with Administrator Yasar. A copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, Sep 29, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Correia conducted an unannounced case management visit to check on the health and safety of residents in care. LPA gained access to the facility, identified herself, and met with the Administrator to discuss the purpose of today's visit. LPA's visit consisted of briefly speaking with Administrator Yasar regarding the resident’s health and safety, and conducted a staff interview, ensuring plans were in place for the protection of the residents in care, concerning assistance with administration of medication and the conditions of the physical plant and maintaining the health and safety of residents in care. LPA did not observe any immediate health and/or safety violations at the time of visit. No deficiencies were issued during today's visit. An exit interview was conducted with Caregiver Bartolome who was informed a copy of this report and Licensee rights will be provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 16, 2025

Allegation investigated: Facility is unsanitary. Facility is understaffed.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to open a complaint investigation. LPA Correia was greeted by Caregiver April Magat, identified herself, and stated the purpose of the visit. The Department’s investigation included staff interviews, and resident and staff records reviews. On September 11, 2025, the Department received a complaint that the facility was unsanitary. Specifically, it was alleged the facility has a cockroach infestation in the kitchen. A tour of the facility kitchen revealed several dead and alive roaches in the kitchen cupboards. Substantiated It was also alleged that the facility is understaffed. During today's visit Staff 1 (S1) was the only staff present to provide all care and meals for five (5) residents, at the time of LPA's arrival. An interview with S1 revealed their main role was working as kitchen staff, however, was capable of providing care for the residents. S1 also disclosed their shift (today) began at 7:00 am. and ends at 6:00 pm., Staff 2 (S2) starts their shift at 8:00 am., who is trained to assist with insulin, however due to car issues did not arrive until 11:30 am., S1 revealed Resident 1 (R1) usually wakes up between 8:30 am. and 9:00 am., upon waking up R1 typically will have assistance to test their blood sugar level to determine if administration of insulin is needed, prior to breakfast. Today, due to S1 not being trained to assist R1 did not receive their testing/injection. Based on Staff interviews, and record reviews, the complaint allegations were determined to be SUBSTANTIATED. A substantiated finding means the preponderance of evidence was met to prove the above listed allegations were met. An exit interview was conducted with Staff Magat and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit. Staff interviews and resident records reviews revealed staff notified R1's hospice agency of the issue and subsequently the hospice agency staff removed R1's catheter. Based on interviews and record reviews the above listed allegation was determined Unsubstantiated. This finding means the preponderance of evidence standard was not met. An exit interview was conducted with Staff Magat and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 15, 2025 · control 08-AS-20250911142556

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 16, 2025

Personnel Requirements - General. Facility personnel shall ... be sufficient in numbers, and competent to provide the services... to meet resident needs... The licensing agency may require any facility to provide additional staff whenever... the extent of services provided, or the physical arrangements of the facility require such additional staff for ... adequate services. This requirement was not met as evidenced by: Based on staff interviews and record reviews they did not have adequate staff to meet Resident 1 (R1) needs. This posed an immediate health risk to one out of five (5) residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2025

Plan of correction: Administrator agreed to have all staff scheduled to attend CCL approved training. Administrator will provide proof of completion by POC due date and completion of training by Friday, September 19, 2025. Administrator will send CCL proof by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Nov 12, 2025

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services...for... well-being of residents...(1) Floor surfaces ...and kitchen areas shall be maintained in a clean, sanitary...condition. This requirement was not as evidenced by: Based on LPA observations the facility kitchen had dead, as well as alive pests, in the kitchen cupboards. This posed a potential health and personal rights risk to five (5) residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2025

Plan of correction: Administrator agreed to have pest control company service the facility, requiring all items to removed from kitchen cabinets and residents to be relocated for the duration of time specified by the company Administrator will send CCL proof of completion by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to conduct the required annual inspection, LPA was greeted by Staff April Magat, identified herself, and was granted entry into the facility. The facility is licensed to serve six (6) residents; of which all can be non-ambulatory, three (3) can be receiving Hospice Services, and one (1) resident may be bedridden. The current census is four (4) residents in care. LPA Correia conducted a resident records review and a partial facility tour. Per today's facility visit resident records were complete and up to date. During the facility tour LPA observed smoke and carbon monoxide detectors were present and operable, fire extinguishers were present and current on inspection, and the facility has a landline. An overall inspection of the facility began today, however due to time constraints LPA was unable to complete the visit and will return later to conduct the remaining portion of this inspection. No deficiencies were cited during today's visit. This report was discussed with Staff Magat, and a copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced case management visit for a Plan of Correction clearance. LPA Rodgers identified herself and was allowed entry by Care Giver Josefina Pilapil. LPA met with Licensee Chen and Administrator Yasar and discussed the purpose of today’s visit. On 8/28/2025 the facility was issued deficiencies and civil penalties (CP's) due on 08/29/2025. During today’s visit, LPA confirmed that the deficiencies were cleared.. The administrator provided documentation of medication training and LPA Rodgers verified a licensed professional they will be coming to the facility three (3) times a day to attend to the medical needs of R1. LPA also Verified all hazardous materials were locked and LPA had chemicals under bathroom sinks relocated to locked garage . An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee Zayden Chen and Administrator Yasar at the conclusion of the visit. The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Aug 29, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Managers (LPMs) Robyn Clark and Lizzette Tellez conducted an unannounced case management deficiencies visit. LPMs were met by Staff 1 (S1), Evangeline Pingul, and were granted entry into the facility. The purpose of the visit was discussed with facility staff. During today's visit, LPMs, along with facility staff, conducted a brief tour of the facility, observed residents in care, and reviewed facility/resident records. Three residents (R1-R3) did not have information or forms as required including LIC 602 (Physicians Report) or LIC 601 (Emergency Identification and Information). Two residents (R4 and R5) did not have information or forms required for their medical assessment (LIC 602 Physicians report, or similar). During the visit, LPM Clark inspected facility time sheet records which indicated that five additional staff members (S2-S6) had time sheets indicating that they had recently worked in the facility. A review of Guardian indicated that only three of those staff members (S1-S3) had active Background Clearance associations to the facility. LPM Clark interviewed Staff 7 (S7) regarding the staff members and S7 reported that they had only worked in the facility for a few weeks and had never met S4, S5, or S6. LPMs conducted a further review of the Guardian Background Clearance System in an attempt to identify the staff members named in the time sheet log. A name search for S4 revealed no results or indications of an active clearance. S5 was discovered with an active clearance however they were associated to a different facility licensed by the Department. [continued on LIC 809(c)]. S6 was associated to the facility on 7/21/2025, however, they were noted as "not hired due to criminal history check." Inspection of facility timesheets indicated that S6 worked in the facility on 7/22/25, 7/23/25, 7/24/25, 7/28/25, 7/29/25, 7/30/25, 7/31/25, and 8/4/2025 despite failing to clear their background check. Deficiencies were cited on the attached LIC 809(d) and Civil Penalties assessed and noted on the LIC421BG. An exit interview was conducted with staff Rivera, and a copy of this report along with Licensee/Appeal Rights were provided at the conclusion of the visit. Their signature on this report acknowledges receipt of these reports and licensee rights.the state’s words, verbatim · CDSS document, Aug 28, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Aug 29, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility (3) Request a transfer of a criminal record clearance... This requirement was not met as evidenced by: Based on record review, the licensee did not ensure that a criminal record clearance transfer was complete for 1 of 7 staff members (S5) prior to working in the facility, which poses an immediate health, safety and personal rights risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: S5 is not present and will not work in the facility until a clearance transfer has been completed and S5 is associated to the facility. POC cleared during the visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: Aug 29, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working... in a licensed facility (2) Obtain a California clearance or a criminal record exemption as required by the Department... This requirement was not met as evidenced by: Based on record review, the licensee did not ensure that a criminal record clearance was obtained for 2 of 7 staff members (S4 and S6) prior to working in the facility, which poses an immediate health, safety and personal rights risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: S4 and S6 are not present and will not work in the facility until obtaining a criminal record clearance and associated to the facility. POC cleared during the visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Sep 26, 2025

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Based on record review, resident records were incomplete for 5 Residents (R1-R5), which poses a potential health, safety and personal rights risk for 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: The licensee will ensure that a separate, complete, and current record is available for every resident in care by the POC due date, and verify by submitting a copy of every resident record to CCL by the POC due date.

Type of visit: Office

Regional Manager (RM) Jerry Romero and Licensing Program Managers (LPMs) Lizzette Tellez and Robyn Clark conducted an Office Meeting and met with Licensee Zayden Chen and Administrator Shamila Yasar to discuss the current licensee status. During today's meeting, RM Romero and facility representatives discussed the current licensee status during the change of ownership process. Review of the Secretary of State website revealed that the Licensee, New World Opco LLC, is currently an active entity. Licensee Chen advised they will maintain communication with the Regional Office throughout the process and ensure oversight throughout the transfer process. LPM Clark provided consultation on the Change of Ownership process. This report was discussed with Mr. Chen. A copy of the report, along with Appeal Rights, were provided to them at the conclusion of the visit, and signature below confirms receipt.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Managers (LPMs) Robyn Clark and Lizzette Tellez conducted an unannounced case management deficiencies visit. LPMs were met by Staff 1 (S1), Evangeline Pingul, and were granted entry into the facility. The purpose of the visit was discussed with facility staff. While exiting the facility after a case management visit, LPMs observed Staff # 8 (S8) administering an injection to Resident # 5 (R5) in their abdominal area. Interview with S8 and review of staff records revealed that S8 is not an appropriately skilled professional, and is therefore not qualified to administer injections to residents in care. Several hazardous items were also observed throughout the facility, which included rubbing alcohol and injection needles left unattended in the main living area, as well as Lysol in the bathroom. Three residents were awake and present. LPMs left the facility at 11:18 a.m, and conducted an in-office meeting with the Licensee to discuss immediate plans of correction. Deficiencies were cited under California Code of Regulations, Title 22 and noted on the attached LIC 809d. A copy of this report, along with Licensee/Appeal Rights was provided to Licensee Zayden Chen. Their signature on this form acknowledges receipt of this report and their rights.the state’s words, verbatim · CDSS document, Aug 28, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Aug 29, 2025

87465 INCIDENTAL MEDICAL AND DENTAL CARE (a) (5) Facility staff... shall not administer injections... This requirement was not met as evidenced by: Based on observation and record review, the licensee did not ensure that an appropriately skilled professional administered medications to 1 (R5) of 5 residents in care. This posed an immediate health, safety and personal rights risk to R5.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: Licensee agreed to immediatley re-train all caregivers in providing assistance with injections and submit proof of training, as well as the complete care plan for R5 by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Aug 29, 2025

87309 Storage Space and Access (a) ...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances... sharp objects, and other... items which could pose a danger... are... not left unattended if outside the locked storage. This requirement was not met as evidenced by: Based on observation, the licensee did not ensure that rubbing alcohol, injection needles, and lysol were locked and inaccessible to residents which poses an immediate health, safety and personal rights risk to 5 of 5 residents in care (R1-R5).the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: Licensee will esure that all hazardous materials are immediatley locked and provide photographic evidence of facility areas by the POC due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced Case Management visit. LPA met with Caregiver Allan Bartolome and discussed the purpose of the visit. During today's visit LPA obtained a signatures on amended Community Care Licensing (CCL) reports. An exit interview was conducted with Caregiver Allan Bartolome*, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) will be provided.the state’s words, verbatim · CDSS document, Aug 7, 2025

Allegation investigated: Licensee hired uncleared staff. Licensee did not provide residents adequate food service. Licensee did not provide essential supplies. Licensee did not meet residents' care needs.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to open a complaint investigation. LPA Correia was greeted by Caregiver Josepina Pilapil, identified herself, and stated the purpose of the visit. The Department’s investigation included staff and resident interviews, and resident and staff records reviews. On July 10, 2025, the Department received a complaint that alleged the Licensee hired uncleared staff to work at the facility, did not provide residents adequate food service, did not provide essential supplies for facility maintenance, and did not meet residents' care needs. A review of staff records revealed all staff had gone through the background check process and were issued clearance. During a tour of the facility LPA observed the facility had an adequate amount of food, including meat and poultry. The facility tour also revealed an adequate amount of incontinent care supplies, as well as cleaning supplies. A resident deemed qualified for an interview revealed no concerns with the food provided at the facility, or any issues with their needs being met. [continued on LIC 9099C] *This is an amended version of the original report delivered on July 18, 2025. Unsubstantiated Based on the evidence obtained from interviews, and record reviews, the complaint allegations were determined to be UNSUBSTANTIATED. An unsubstantiated finding means the preponderance of evidence was not met. An exit interview was conducted with Caregiver Evangeline Pingul and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit. *This is an amended version of the original report dated July 18, 2025.the state’s words, verbatim · CDSS document, Jul 17, 2025 · control 08-AS-20250710104715

Type of visit: Collateral

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Collateral visit. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Caregiver Nirissa Imperial. During today's visit, LPA observed residents in care, reviewed and obtained copies of facility records, and interviewed staff. No deficiencies were observed or cited during today's visit. An exit interview was conducted with Caregiver Nirissa Imperial, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Oct 17, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ryan Fulton conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to the applicant’s representative, Administrator Zayden Chen The facility fire clearance was granted on 8/09/2024 and reflected that the facility was approved for six (6) residents in total, of which five (5) may be non-ambulatory and one (1) may be bedridden. The facility's fire clearance did include delayed-egress door and secured perimeter endorsements. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPA, accompanied by the applicant’s representative, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was compliant at 73 degrees F. Hot water temperature at taps accessible to residents were also compliant: Kitchen sink was 119.8 F, Bathroom #1 sink was 119.4 F, and Bathroom #2 sink was 118.2 F. The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant’s representative, no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguisher were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. Administrator Zayden Chen was advised that the facility’s application is pending management final review and approval. An exit interview was conducted with the applicant’s representative Administrator Zayden Chen, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Aug 29, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census : 6 Method: Telephone call with CAB COMP II Participants: Zayden Chen (Administrator/Licensee) & Tammy Edwards (Analyst). Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee'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, Aug 2, 2024