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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423880
Report Date: 12/29/2022
Date Signed: 12/29/2022 12:40:42 PM


Document Has Been Signed on 12/29/2022 12:40 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:ALEJANDRA PERDOMOFACILITY TYPE:
740
ADDRESS:2600 SOUTH MAIN STREETTELEPHONE:
(951) 736-4780
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:49CENSUS: 13DATE:
12/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Courtney Barreto- AdministratorTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Victoria Chitgian made an unannounced visit to conduct an annual inspection focused on infection control. LPA met with Administrator Courtney Barreto and explained the purpose of the visit.

LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed proper signs posted throughout the facility, sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer and paper towels). LPA observed a thirty (30) day supply of Personal Protective Equipment (PPE) which includes gloves, gowns, surgical masks, N95 masks, disinfectant, and hand sanitizer. PPE was stored in a hallway storage room.

The facility has a plan in place which follows Community Care Licensing Division guidelines for testing, isolating and caring for residents with COVID-19 positive and/or exposures. There is a designated infection control lead person tasked with tracking all positive cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in effect, and that staff are trained in the proper use and disposal of PPE. The facility staff monitors residents regularly for any changes in condition and daily symptom checks. The staff will contact the resident's physician in the event of any Covid-19 related illnesses. The staff are responsible for cleaning and disinfecting the highly touched surface areas during their shift. All staff and residents are practicing all other infection control precautions, which minimize the risk of them contracting Covid-19.

LPA completed a walk-through of the facilities interior and exterior and there were no health and safety concerns. 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 a copy of this report (LIC809) was provided to Administrator Courtney Barreto.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Victoria ChitgianTELEPHONE: (951) 248-0306
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2022
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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