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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604048
Report Date: 05/02/2022
Date Signed: 05/02/2022 02:10:27 PM


Document Has Been Signed on 05/02/2022 02:10 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:BONITA GUEST HOME LLCFACILITY NUMBER:
374604048
ADMINISTRATOR:ALEX C CAROLINOFACILITY TYPE:
740
ADDRESS:5735 SUNNY VIEW DRIVETELEPHONE:
(619) 472-8884
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY:6CENSUS: 5DATE:
05/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Caregiver, Adelina CabreraTIME COMPLETED:
11:50 AM
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Licensing Program Analyst, (LPA) Marisela Garcia-Centeno, made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself, and met with Caregiver, Adelina Cabrera and discussed the purpose of today’s visit.

A tour of the facility was conducted inside and out. LPA conducted a general overall inspection, with specific focus on infection control

During today's inspection LPA observations include the following: Symptom screening procedures for staff, residents and visitors; posted signs regarding visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; Hand hygiene practices; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures.

Based on today’s inspection, no deficiencies were observed at this time in the areas evaluated. This report was discussed with Caregiver Adelina Cabrera. A copy of this report along with Licensee Rights (01/2016) was provided to Caregiver, Cabrera at the conclusion of the exit conference.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2022
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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