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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603136
Report Date: 06/03/2020
Date Signed: 06/03/2020 04:08:36 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: 72DATE:
06/03/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:59 AM
MET WITH:Administrator, Elizabeth ReyesTIME COMPLETED:
12:21 PM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced Case Management tele-visit via FaceTime due to COVID-19. LPA Hamilton identified herself to the Administrator, Elizabeth Reyes, and discussed the purpose of the visit.

Today’s visit is in response to the self reported incident of Resident 1, received in Regional Office on May 15, 2020.

During today’s visit, LPA Hamilton interviewed the Administrator and requested resident records.

No deficiencies were cited during this visit.

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

DATE: 06/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2020
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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