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25 | Facility Type: RCFE
Application Type: CHOW
Capacity: 100
Method: Telephone call with CAB
Applicant/administrator participated in COMP II via telephone call with the analyst at CAB.
Identification of the applicant and administrator was verified by correctly answering identity
verification question. During COMP II, applicant and administrator confirmed the
understanding of Title 22. Component II was successfully completed. Applicant has been
advised to transmit 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 property |