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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601134
Report Date: 06/19/2020
Date Signed: 06/19/2020 02:18:34 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:SUNRISE AT LA COSTAFACILITY NUMBER:
374601134
ADMINISTRATOR:LAVENDER, WESLEY DFACILITY TYPE:
740
ADDRESS:7020 MANZANITA STTELEPHONE:
(760) 930-0060
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:120CENSUS: 65DATE:
06/19/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Executive Director, Wesley LavenderTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Eva Torres conducted a virtual case management visit via FaceTime to follow up on report that was submitted by the facility on 06/18/20. LPA identified herself, spoke with Executive Director, Wesley Lavender, and disclosed the purpose of the phone call.

During the call, LPA obtained information surrounding the incident in question and requested records.

An exit interview was conducted with the Executive Director, and the Licensee’s Rights (LIC9058 01/15) along with a copy of this report was provided to Executive Director, Wesley Lavender via email. A reply email or return receipt from Executive Director will confirm receipt of documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Evangelica TorresTELEPHONE: (619) 990-1407
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2020
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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