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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530036
Report Date: 11/22/2023
Date Signed: 11/22/2023 10:01:06 AM

Document Has Been Signed on 11/22/2023 10:01 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, 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:
11/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Diane Johnson- Facility ManagerTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Manager Diane Johnson and was granted entry to the facility. At the time of the visit there were no clients present. The facility is waiting on client placement from Inland Regional Center. The facility has not had any clients since they opened the facility in October of 2022.

The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, and a non-attached garage. The facility is an Adult Residential Facility (ARF) level 4i home vendorized by Inland Regional Center. The facility is licensed for a capacity of four (4) clients. LPA was accompanied by Facility Manager to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: There are no obstructions to the indoor and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 120 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to upcoming clients. There is a designated storage space for upcoming client/staff files. Medications will be kept inside a locked cabinet inaccessible to upcoming clients. Overall, the facility is clean, in good repair, and operating in safe conditions for take clients.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CORONADO HOME
FACILITY NUMBER: 335530036
VISIT DATE: 11/22/2023
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Record Review: The facility does not have clients living at the facility or staff on roster due to not having clients.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Manager Diane Johnson.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2023
LIC809 (FAS) - (06/04)
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