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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603660
Report Date: 06/30/2022
Date Signed: 06/30/2022 01:47:41 PM


Document Has Been Signed on 06/30/2022 01:47 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: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: 16DATE:
06/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maria FloresTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to deliver an amended report for a visit conducted on 7/14/2021. LPA was greeted by, identified herself to, and explained the purpose of the visit to Administrator Maria Flores.

During the visit, LPA obtained Maria Flores' signature on the amended complaint investigation report - LIC 9099.

An exit interview was conducted with Administrator Maria Flores, to whom a copy of this report and the Licensee's Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022
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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