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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600799
Report Date: 01/29/2021
Date Signed: 01/29/2021 02:08:51 PM

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:CARLSBAD BY THE SEAFACILITY NUMBER:
374600799
ADMINISTRATOR:JOAN E. JOHNSONFACILITY TYPE:
741
ADDRESS:2855 CARLSBAD BLVD.TELEPHONE:
(760) 729-2377
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:224CENSUS: 174DATE:
01/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director Joan JohnsonTIME COMPLETED:
01:35 PM
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Licensing Program Manager (LPM) John Rante conducted a Tele-Virtual Visit due to COVID-19. LPM identified himself to the Executive Director, Joan Johnson, and we discussed the purpose of the visit.

Today's virtual visit is to deliver amended reports to the facility. Amended reports were sent via email to the Executive Director on this date.

No deficiencies were cited or observed on this date.

An exit interview was conducted with the Johnson. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Johnson via email with an electronic read receipt.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021
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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