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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600637
Report Date: 08/01/2022
Date Signed: 08/02/2022 09:28:31 AM


Document Has Been Signed on 08/02/2022 09:28 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:LA COSTA GLEN CARLSBADFACILITY NUMBER:
374600637
ADMINISTRATOR:KEARNAGHAN, KRISTENFACILITY TYPE:
741
ADDRESS:1950 SILVERLEAF CIRCLETELEPHONE:
(760) 704-1000
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:1233CENSUS: 805DATE:
08/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kristen Kearnaghan, Executive DirectorTIME COMPLETED:
03:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced Case Management visit. After introducing herself, LPA was granted entry into the facility. LPA met with Kristen Kearnaghan, Executive Director, and Cathie Dozier, Resident Health Services Director, to whom she disclosed the purpose of the visit.

This visit was initiated in response to a self-reported incident that was reported to Community Care Licensing, via incident report, on July 29, 2022. During today's visit, LPA toured the facility, obtained copies of facility records, and briefly spoke to residents in care. LPA did not observe any immediate health and/or safety issues during the visit.

No deficiencies were cited during today's visit. This report was discussed with Kristen Kearnaghan, Executive Director. Copies of this report and Licensee/Appeal Rights were provided to the Executive Director at the conclusion of the visit. Kristen Kearnaghan's signature on this report acknowledges receipt of a copy of the rights and the report.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2022
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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