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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603660
Report Date: 05/26/2023
Date Signed: 05/26/2023 11:19:20 AM


Document Has Been Signed on 05/26/2023 11:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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:
05/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Alma Saenz, Med TechTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced case management visit. LPA was greeted and allowed entry into the facility by Alma Saenz, Med Tech. LPA stated the purpose of the visit was to conduct a health and safety check and collect records.

During today's visit, LPA conducted a brief facility tour, interacted with residents and staff and obtained facility records. No deficiencies were observed or cited during this visit.

An exit interview was conducted and a copy of this report along with Licensee Rights (LIC9058 03/22) were provided to Ms. Saenz whose signature below confirms receipt of these rights.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023
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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