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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603660
Report Date: 03/05/2021
Date Signed: 03/05/2021 05:42:16 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:BAYVIEW SENIOR ASSISTED LIVINGFACILITY NUMBER:
374603660
ADMINISTRATOR:JEFFREY SETTINERIFACILITY TYPE:
740
ADDRESS:3219 CANON STREETTELEPHONE:
(619) 225-5616
CITY:SAN DIEGOSTATE: CAZIP CODE:
92106
CAPACITY:17CENSUS: 13DATE:
03/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:House Manager: Maria FloresTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Eva Torres conducted a virtual case management visit via FaceTime to review and discuss the Mitigation Plan, as well as provide technical assistance surrounding COVID-19. LPA identified herself and discussed the purpose of the phone call with House Manager, Maria Flores.
During the call, LPA inspected the facility’s screening areas, observed their sanitation supplies, and personal protective equipment (PPE). LPA also reviewed the Mitigation Plan with Mrs. Flores and provided consultation while evaluating the facility's disinfection, surveillance testing, and screening protocols, as well as the use of PPE.
An exit interview was conducted with Mrs. Flores and a copy of this report, along with Licensee Rights (LIC 9058 01/16), was provided to them via email. A reply email or return receipt from the House Manager will confirm receipt of documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica TorresTELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021
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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