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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530056
Report Date: 09/29/2022
Date Signed: 09/29/2022 11:23:12 AM

Document Has Been Signed on 09/29/2022 11:23 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
CCLD Regional Office, 744 P STREET, MS 9-14-8201
, CA 95814
FACILITY NAME:CORONA CARE HOME INC.FACILITY NUMBER:
335530056
ADMINISTRATOR:CALILUNG, VANESSA S.FACILITY TYPE:
740
ADDRESS:1664 TAMARRON DRIVETELEPHONE:
(714) 906-6046
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY: 6CENSUS: 0DATE:
09/29/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Restituto Calilung; Vanessa CalilungTIME COMPLETED:
10:28 AM
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Facility Type: RCFE
Application Type: INITIAL
Capacity: 6
Census (if any clients in care): 0
COMP II Participants: Restituto Calilung CEO; Vanessa Calilung Administrator

Interview Method: Telephone interview with CAB

During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Procedures
3. Staffing requirements & Training
4. Program policies -restricted/prohibited health conditions; food service management; emergency procedures; medication management; activities program
5. Complaints & Reporting
6. Application document review and technical assistance- Criminal record clearance; Health screening; Fire clearance; First Aid/CPR certificate; Administrator certificate; Financial verification; Compliance history; Control of property
SUPERVISORS NAME: Tracy Thompson
LICENSING EVALUATOR NAME: Ricmar Soriano
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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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