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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603394
Report Date: 03/15/2022
Date Signed: 03/15/2022 02:28:10 PM


Document Has Been Signed on 03/15/2022 02:28 PM - It Cannot Be Edited

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:
03/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Executive Director Roxanne GoodingTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management Visit. LPA met with Executive Director Roxanne Gooding. LPA identified herself and discussed the purpose of the visit.
Today's visit is in response to the self-reported incident which occurred on 3/2/2022 regarding the fall of Resident 1 (R1 - see LIC811 Confidential Names List).

LPA conducted a wellness check at the facility, and no health or safety issues were identified. Residents observed appeared appropriate for the facility.

No deficiencies were cited or observed on this date.

An exit interview was conducted with the Executive Director. A copy of this report and appeal rights (LIC9056 01/16), were provided via hardcopy.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Kayla HilarioTELEPHONE: 619-481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2022
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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