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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423880
Report Date: 11/21/2023
Date Signed: 11/21/2023 09:46:23 AM


Document Has Been Signed on 11/21/2023 09:46 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: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: 13DATE:
11/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Jennifer D. MontgomeryTIME COMPLETED:
09:55 AM
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management visit to indicate who is the new Administrator.

During today’s visit, LPA obtained documents of the Designated Administrator.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Jennifer D. Montgomery.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
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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