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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603136
Report Date: 07/14/2020
Date Signed: 07/14/2020 04:10:57 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: 70DATE:
07/14/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:42 PM
MET WITH:HR Business Office Assistant, Yasmin GomezTIME COMPLETED:
04:05 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 HR Business Office Assistant, Yasmin Gomez, and discussed the purpose of the visit.

Today’s visit is in response to the closure of the kitchen.

During today’s visit, LPA Hamilton toured the facility.

No deficiencies were cited during this visit.

An exit interview was conducted with HR Business Office Assistant, Yasmin Gomez via FaceTime and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to HR Business Office Assistant via email. An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2020
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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