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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423880
Report Date: 03/25/2021
Date Signed: 03/25/2021 04:40:49 PM

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
RIVERSIDE, CA 92507
FACILITY NAME:VISTA COVE AT CORONAFACILITY NUMBER:
336423880
ADMINISTRATOR:ALEJANDRA PERDOMOFACILITY TYPE:
740
ADDRESS:2600 SOUTH MAIN STREETTELEPHONE:
(951) 736-4780
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:49CENSUS: 14DATE:
03/25/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Bonaparte Liu, Vista Cove at Corona, Inc.TIME COMPLETED:
03:30 PM
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Regional Manager (RM) Leslie Mendiveles, Licensing Program Manager (LPM) Reyna Lacey and Licensing Program Analyst (LPA) Tricia Danielson met with Bonaparte Liu of Vista Cove at Corona Inc., who is identified as one of the Licensees of the facility. The purpose of the meeting was to discuss alleged breaches of the tenant's lease agreement and to clarify who is responsible for the operation of the facility.

Mr. Liu stated the facility was sold November 30, 2016. Community Care Licensing Division (CCLD) staff were informed the buyer was to submit an application to obtain a CCLD license upon finalization of the purchase. Mr. Liu provided documentation to CCLD staff during the meeting.

Mr. Liu was advised the documentation would be reviewed and follow up may be required to verify regulations and Health & Safety (H&S) laws were adhered to, specifically H&S 1569.191.

A copy of this report was provided to Mr. Liu via email.

SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021
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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