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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423880
Report Date: 09/14/2023
Date Signed: 09/14/2023 01:23:53 PM


Document Has Been Signed on 09/14/2023 01:23 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:VISTA COVE AT CORONAFACILITY NUMBER:
336423880
ADMINISTRATOR:COURTNEY BARRETOFACILITY TYPE:
740
ADDRESS:2600 SOUTH MAIN STREETTELEPHONE:
(951) 736-4780
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:49CENSUS: 12DATE:
09/14/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Administrator Courtney BarretoTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management visit regarding the facility fire clearance status and providing care for one (1) bedridden resident. LPA Rico met with Administrator Courtney Barreto and explained the reason for today's visit.

During today’s visit, LPA discovered the facility has not relocated the one (1) bedridden resident. LPA toured R1 bedroom and confirmed that R1 residences at the facility. Resident received their 30day notice on 8/2/2023.

During interview with Administrator, Administrator stated facility does not have their fire clearance from Corona Fire Department. Administrator informed LPA the facility has an office meeting on 9/20/2023 with HCAI.

Based on today's observation, two (2) civil penalties in the amount of $5,600 and $4,800 dollars will be issued for failure to correct the two (2) violations within a specified length of time that result in a civil penalty. The facility will be issued two (2) civil penalties 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 Administrator Courtney Barreto along with a copy of the two(2) LIC421IM and along with the appeal rights.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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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