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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603394
Report Date: 08/10/2021
Date Signed: 08/10/2021 03:33:09 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: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: 61DATE:
08/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Executive Director, Roxanne GoodingTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an annual required licensing inspection. This annual inspection was focused on infection control due to the COVID-19 pandemic. LPA Hamilton gained access to the facility, met with Executive Director, Roxanne Gooding and explained the purpose of the visit. This facility serves ninety-six (96) non-ambulatory residents; age 60 and above; twelve (12) of whom may be bedridden. Hospice care waiver approved for twenty-five (25).

During today's visit, LPA toured the facility, and verified compliance with infection control practices. LPA and Executive Director reviewed the facility’s COVID-19 Mitigation Plan. LPA observed one central entry point; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs throughout the facility to promote face coverings, face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area and an adequate supply of PPE and disinfectants.

Based on today's visit, no deficiencies were observed in the areas evaluated above. An exit interview was conducted with Executive Director and a copy of this report along with the Licensee/Appeal Rights (LIC 9058) was provided via email. An electronic receipt of confirmation was requested to be sent by the Licensee 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: 08/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021
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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