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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603136
Report Date: 09/11/2020
Date Signed: 09/11/2020 03:40:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CORONADO RETIREMENT VILLAGEFACILITY NUMBER:
374603136
ADMINISTRATOR:ELIZABETH REYESFACILITY TYPE:
740
ADDRESS:299 PROSPECT PLACETELEPHONE:
(619) 437-1777
CITY:CORONADOSTATE: CAZIP CODE:
92118
CAPACITY:120CENSUS: 63DATE:
09/11/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Administrator, Elizabeth ReyesTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted a Case Management tele-visit. This visit was conducted via FaceTime due to COVID-19. LPA identified herself and discussed the purpose of the visit with Administrator, Elizabeth Reyes.

The purpose of the visit was to discuss Incident Reports received in our office on 09/09/2020. During today’s visit, LPA interviewed staff and residents and requested copies of records. No deficiencies were observed during today’s visit.

An exit interview was conducted with the Administrator, Elizabeth Reyes and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Elizabeth Reyes via email with an electronic read receipt.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
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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