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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604757
Report Date: 09/17/2024
Date Signed: 09/17/2024 01:12:35 PM


Document Has Been Signed on 09/17/2024 01:12 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:IVY PARK AT BONITAFACILITY NUMBER:
374604757
ADMINISTRATOR:GOODING, ROXANNEFACILITY TYPE:
740
ADDRESS:3302 BONITA ROADTELEPHONE:
(619) 470-2220
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:96CENSUS: 61DATE:
09/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Randal NewtonTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Ramon Serrano, conducted an announced Pre-Licensing inspection. LPA met with Executive Director Randal Newton and we discussed the purpose of the visit.

LPA conducted a tour of the facility, both inside and outside. Their are no bodies of water on the premises. LPA inspected three resident rooms in both the assisted living section and the memory care unit. The smoke and carbon monoxide alarms were present. Toilets intended for resident use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, curtains and paint throughout the rooms and the facility, were observed in good condition. Each room intended for resident use had the appropriate furniture, bedding and appropriate lighting. Licensee stated there are no firearms stored on the premises.

Hot water temperature was measured at different locations throughout the facility including resident rooms and the two kitchen areas. The average hot water temperature was 115 degrees F. The ambient temperature inside the facility and resident rooms was measured at an average of 74 degrees F. The facility was observed to be clean and kempt with no strong malodors. The main kitchen refrigerator and freezer was observed to be clean and operational, with an ample amount of food to meet resident needs. Cleaning solutions were also properly secured in the various laundry rooms and storage areas.

The Component III portion of the application process was completed with Executive Director Randal Newton on today's date as well.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted with Randal Newton and a copy of this report along with Licensee Rights was provided to Randal Newton whose signature below verifies receipt of these.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024
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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