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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530036
Report Date: 09/22/2022
Date Signed: 09/22/2022 10:39:33 AM

Document Has Been Signed on 09/22/2022 10:39 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:CORONADO HOMEFACILITY NUMBER:
335530036
ADMINISTRATOR:MARBY, RENEEFACILITY TYPE:
735
ADDRESS:205 CORONADO DRIVETELEPHONE:
(310) 940-2828
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 4CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Renee Marby- Licensee/AdministratorTIME COMPLETED:
10:49 AM
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Licensing Program Analyst (LPA) Ryan Gardner conducted an announced visit to complete the Pre-licensing inspection and Component III presentation. LPA met with Licensee/Administrator, Renee Marby. This application is for an Adult Residential Care Facility for four (4) ambulatory clients. The fire clearance was approved on 8/18/2022.

The facility is a four (4) bedroom, two (2) bath home. There are four (4) client bedrooms, two (2) bathrooms, a kitchen/dining area, two (2) living room areas, an office space, a backyard, and attached garage. LPA and Licensee/Administrator toured the interior and exterior areas of the facility. The following were inspected:



Client Bedrooms: All the client bedrooms have the required bedding and furniture, such as, clean mattresses/linen, mattress covers, nightstands, dressers/closets, chairs, and lighting.

Client Bathrooms: The bathroom appliances were operating in safe and sanitary condition. The water temperature was measured by LPA, the thermometer read at 111.3 degrees F.

Kitchen and Dining Areas: Utensils and dishware are in good repair and ready for client use. Kitchen appliances and countertop were free of debris and in good repair. The refrigerator was measured at 45 degrees F and the freezer was measured at 0 degrees F. The knives and sharps were safely locked and secured. The medication cabinet was safely secured and locked. The chemicals were safely locked in the storage cabinet in the front entry way.

Common Living Areas: There is adequate seating in the common living areas. The facility has a supply of activities for the clients. LPA observed the air conditioning to be in working condition and was set at 70 degrees F.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: CORONADO HOME
FACILITY NUMBER: 335530036
VISIT DATE: 09/22/2022
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Laundry Room: The laundry area and laundry supplies were located in the locked garage.

Linens and Hygiene Supplies: The facility has an adequate supply of linens and hygiene/toiletries for the clients.

Backyard: There are no bodies of water in the backyard. There is a covered area with seating for the clients. All passageways were free from obstruction.

Fire extinguisher and carbon monoxide: There are two (2) charged fire extinguishers in the facility. There were operating smoke detectors and carbon monoxide alarms observed at the time of visit.

Postings: LPA observed the required postings including the visitation polices, emergency/disaster plans, complaint procedures, and personal rights.

First aid and working telephone: The facility was equipped with a complete first aid kit and manual. The facility has working telephone for client use.

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA has determined that the facility meets operational requirements for licensure. The Pre-licensing inspection is complete, and this facility has no deficiencies. The Licensee has satisfied all requirements in accordance with Title 22, California Code of Regulations.

LPA and Renee Marby completed the Comp III presentation during today’s visit.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Licensee/ Administrator, Renee Marby.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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