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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603394
Report Date: 05/06/2021
Date Signed: 05/06/2021 11:15:26 AM

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:SUNRISE ASSISTED LIVING AT BONITAFACILITY NUMBER:
374603394
ADMINISTRATOR:GOODING, ROXANNEFACILITY TYPE:
740
ADDRESS:3302 BONITA RDTELEPHONE:
(619) 470-2220
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:96CENSUS: 55DATE:
05/06/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:Executive Director, Roxanne GoodingTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced virtual Case Management visit via FaceTime due to COVID-19. LPA identified herself and discussed the purpose of the visit with Executive Director, Roxanne Gooding.

The purpose of the visit was to discuss an Incident Report received in our office on May 3, 2021. During today’s visit, LPA interviewed Executive Director and briefly toured the facility. No deficiencies were observed during today’s visit.

An exit interview was conducted with the Executive Director and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Executive Director via email. An electronic receipt of confirmation was requested to be sent by the Executive Director upon receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021
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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