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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600637
Report Date: 02/07/2022
Date Signed: 02/07/2022 11:08:29 AM

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:LA COSTA GLEN CARLSBADFACILITY NUMBER:
374600637
ADMINISTRATOR:GALLAGHER, DAVIDFACILITY TYPE:
741
ADDRESS:1950 SILVERLEAF CIRCLETELEPHONE:
(760) 704-1000
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:1233CENSUS: 796DATE:
02/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Kristen KearnaghanTIME COMPLETED:
10:19 AM
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Licensing Program Analyst (LPA) Ramon Serrano and County of San Diego Public Health Nurses Jennifer West and Sandra Brackman conducted an on-site HAI assessment visit. LPA Serrano and team identified themselves and discussed the purpose of the visit with Executive Director (ED) Kristen Kearnaghan

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, LPA Serrano and Nurses Jennifer West and Sandra Brackman conducted a walk-though of the facility. A debriefing was conducted with ED Kristen Kearnaghan at the conclusion of the visit.

No deficiencies were cited during today's visit. An exit interview was conducted with ED Kristen Kearnaghan and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to PD, via electronic mail. An electronic receipt of confirmation was requested to be sent by the PD upon receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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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