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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603715
Report Date: 05/31/2024
Date Signed: 05/31/2024 10:47:07 AM


Document Has Been Signed on 05/31/2024 10:47 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:HARBORVIEW SENIOR ASSISTED LIVINGFACILITY NUMBER:
374603715
ADMINISTRATOR:SETTINERI, JEFFREYFACILITY TYPE:
740
ADDRESS:2360 ALBATROSS STREETTELEPHONE:
(619) 233-8382
CITY:SAN DIEGOSTATE: CAZIP CODE:
92101
CAPACITY:30CENSUS: 28DATE:
05/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gladys Vincent, Compliance AnalystTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced case management visit to follow-up on consultation provided during a required annual inspection on May 15, 2024. After identifying himself and explaining the reason for the visit, LPA was allowed into the facility. LPA met with Gladys Vincent, Compliance Analyst.

During the visit, LPA toured the facility, inside and out, reviewed records and interacted with residents in care.

No deficiencies were cited.

An exit interview was conducted with Ms. Vincent. A copy of this report and Licensee Rights (LIC 9058/16) were provided to Ms. Vincent, and her signature on this form confirms receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024
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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