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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134604807
Report Date: 06/24/2024
Date Signed: 06/24/2024 04:19:55 PM

Document Has Been Signed on 06/24/2024 04:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:COMPASSIONATE SENIOR CARE 247 INC.FACILITY NUMBER:
134604807
ADMINISTRATOR/
DIRECTOR:
ZADEH, DIANAFACILITY TYPE:
740
ADDRESS:103 S. HASKELL DRIVETELEPHONE:
(760) 791-8818
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY: 14CENSUS: 14DATE:
06/24/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Carlos Ramirez, ApplicantTIME VISIT/
INSPECTION COMPLETED:
04:13 PM
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Component II completion: Successful

Facility Type: Residential Care Facility for the Elderly (RCFE)
Application Type: Change in Ownership (CHOW)
Capacity: 14
Census (if any clients in care): 10
COMP II Participants: Carlos Ramirez, Applicant
Interview Method: Telephone interview


On June 24, 2024 at 3:00 PM, applicant participated in COMP II. Identification of the applicant was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22.
During COMP II, CAB analyst confirmed Applicant’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 Readiness

Exit interview conducted with Applicant. Copy of report sent to applicant and request to return sign copy by end of business day today.
SUPERVISORS NAME: Darla Neeley
LICENSING EVALUATOR NAME: Celia Phomphachanh
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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