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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603660
Report Date: 07/08/2022
Date Signed: 07/08/2022 03:33:49 PM


Document Has Been Signed on 07/08/2022 03:33 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
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: 15DATE:
07/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Maria Flores, AdministratorTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced annual required licensing inspection. LPA was greeted at the entrance to the facility by Caregiver, Anna Sanchez. After identifying himself and stating the reason for the visit, LPA was permitted entry into the facility. LPA was later met by Administrator, Maria Flores to verify compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices.

LPA conducted a tour of the facility and observed the residents in care. In accordance with the Department’s Infection Control, LPA provided consultation, observed, and evaluated the facility's implementation of their Infection Control Plan, to include disinfection, testing, vaccination, screening protocols, and the use of personal protective equipment.

No deficiencies were observed during today’s visit. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator, Flores 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: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2022
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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