336423880-12-12-2023-56-AS-MRIO-CYFSAV-20231212124258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336423880
Report Date: 12/12/2023
Date Signed: 12/12/2023 12:43:10 PM

Document Has Been Signed on 12/12/2023 12:43 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 CORONA		FACILITY NUMBER:	336423880
ADMINISTRATOR:	COURTNEY BARRETO		FACILITY TYPE:	740
ADDRESS:	2600 SOUTH MAIN STREET		TELEPHONE:	(951) 736-4780
CITY:	CORONA	STATE: CA	ZIP CODE:	92882
CAPACITY:	49	CENSUS: 13	DATE:	12/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Jennifer D. Montgomery		TIME COMPLETED:	12:50 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Jennifer D. Montgomery and was granted entry to the facility. Licensed capacity is (49) current census (13). LPA was accompanied by Administrator Jennifer D. Montgomery to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor 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. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated office for client/staff files.

The facility is on a 24-hour fire watch until their Fire Clearance has been approved. During today’s visit LPA observed a fire panel install at the facility. Administrator informed LPA, the facility has a schedule appointment with Corona Fire Department on 12/14/2023 for their pending Fire Clearance.

Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: VISTA COVE AT CORONA	FACILITY NUMBER: 336423880
	VISIT DATE: 12/12/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Record Review: LPA reviewed (13) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (13) client medications. LPA also reviewed (4) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings.

LPA Rico informed Administrator that Community Care Licensing Department has not received the following documents: 1. Property Agreement between Property Owner (Landlord) and Licensee (Corona RCFE, LLC) 2. Written Agreement between Vista Cove, INC and Corona RCFE LLC which removes Vista Cove, INC as the Licensee.

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 Administrator Jennifer D. Montgomery

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2