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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880546
Report Date: 11/13/2023
Date Signed: 11/13/2023 12:47:33 PM


Document Has Been Signed on 11/13/2023 12:47 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:ESTANCIA DEL SOLFACILITY NUMBER:
331880546
ADMINISTRATOR:LISA HUNTFACILITY TYPE:
740
ADDRESS:2489 CALIFORNIA AVETELEPHONE:
(951) 268-9697
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:135CENSUS: 125DATE:
11/13/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Lisa Hunt- AdministratorTIME COMPLETED:
12:53 PM
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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to conduct a Health and Safety check at the facility. The Health and Safety check was completed at same time as the annual inspection. LPA met with Administrator Lisa Hunt and explained the reason for the visit.

The Health and Safety check included overall observation of the facility inside and outside, including food supply, medications, physical plant, and residents in care. During kitchen tour, LPA found a tray of Jello uncovered in the refrigerator. The facility was issued a type B deficiency on the LIC809 annual inspection for not covering the Jello in the refrigerator.

Based on the observations made during today’s visit, one (1) deficiency was cited on the annual inspection per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted where this report was discussed, and a copy of this report was provided to Administrator Lisa Hunt at the conclusion of the visit.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan GardnerTELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:
DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2023
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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