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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426434
Report Date: 02/27/2024
Date Signed: 02/27/2024 12:14:35 PM


Document Has Been Signed on 02/27/2024 12:14 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:BROOKDALE CORONAFACILITY NUMBER:
336426434
ADMINISTRATOR:BRITTNEY MARTINEZFACILITY TYPE:
740
ADDRESS:2005 KELLOGG AVETELEPHONE:
(951) 898-6991
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:60CENSUS: 37DATE:
02/27/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Brittney Martinez- AdministratorTIME COMPLETED:
12:23 PM
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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to conduct a Health and Safety check of the residents in care. LPA met with Administrator Brittney Martinez and explained the reason for the visit.

The Health and Safety check included overall observation of the facility inside and outside, including food supply, medications, physical plant, and the residents in care. LPA did not observe any safety hazards.

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 where this report (LIC 809) was discussed, and a copy was provided to Administrator Brittney Martinez at the conclusion of the visit.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan GardnerTELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024
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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