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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423880
Report Date: 08/04/2021
Date Signed: 08/04/2021 12:40:51 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: 11DATE:
08/04/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alejandra PerdomoTIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Jennifer Semin made an unannounced visit to conduct a health and safety check. LPA met with Administrator, Alejandra Perdomo. Ms. Perdomo contacted the licensee Chiam Raskin via email and LPA spoke to Mr. Raskin via telephone.

LPA Semin and Ms. Perdomo toured the facility inside and out and did not observe any immediate health and safety concerns during the tour.

LPA and Mr. Raskin discussed submitting the documents to remove Vista Cove at Corona Inc. from the license. LPA provided Ms. Perdomo with a copy of the application instructions. Mr. Raskin stated he will submit all the required documentation to Centralized Applications Bureau (CAB) by end of business today 8/18/2021.

Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care.
No deficiencies were cited during today's visit.

An exit interview was conducted where this report was discussed and provided to Ms. Perdomo.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer SeminTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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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