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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600026
Report Date: 08/22/2024
Date Signed: 08/23/2024 06:52:06 AM


Document Has Been Signed on 08/23/2024 06:52 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,
, CA



FACILITY NAME:SILVERGATE SAN MARCOS RETIREMENT RESIDENCEFACILITY NUMBER:
374600026
ADMINISTRATOR:JOAN RINK-CARROLLFACILITY TYPE:
740
ADDRESS:1550/1560 SECURITY PLACETELEPHONE:
(760) 744-4484
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:160CENSUS: 95DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Joan Rink-CarrollTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to obtain signatures on an amended report. During today’s visit, LPA was greeted by the Lead Front Desk Receptionist Edgar Baltazar, identified herself and met with Administrator Rink-Carroll and discussed the purpose of the visit.

During today’s visit, LPA obtained Administrator's signature on an amended version of a report originally delivered on August 14, 2024.

An exit interview was conducted with Administrator Rink-Carroll a and a copy of this report and the Licensee Appeal Rights (LIC 9058 3/22) were provided.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 380-3797
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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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