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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600344
Report Date: 09/21/2022
Date Signed: 09/21/2022 10:26:17 AM


Document Has Been Signed on 09/21/2022 10:26 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:PACIFICA SENIOR LIVING ENCINITAS NORTHFACILITY NUMBER:
374600344
ADMINISTRATOR:BURWIN, SUSANFACILITY TYPE:
740
ADDRESS:480 S EL CAMINO REALTELEPHONE:
(760) 436-6955
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:65CENSUS: 0DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Melissa WatkinsTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted a case management visit to process the facility’s request for closure. LPA was greeted by, identified herself to, and explained the purpose of the visit to Executive Director Melissa Watkins.

On 8/1/2022, the Department received a letter stating that the facility is closing. The letter stated there are no residents in care at that time.

During today’s visit, LPA toured the facility and observed there were no residents in care. All licensing postings have been removed. Melissa Watkins confirmed residents have not resided at this location since June 2022. No deficiencies were issued and the facility is ready for closure.

An exit interview was conducted with Executive Director Melissa Watkins, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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