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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601134
Report Date: 06/17/2020
Date Signed: 06/17/2020 02:20:44 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: 68DATE:
06/17/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Executive Director, Wes Lavender and Dawn Thompson, Business Office CoordinatorTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA), Jonathan Pineda, conducted a case management virtual visit regarding an incident reports received at the San Diego Regional Office on June 8, 2020. Virtual visits are being conducted due to COVID-19. LPA spoke with Executive Director, Wes Lavender, via FaceTime. LPA identified himself and stated the purpose of the call.

During today's call, LPA interviewed staff regarding the incident and reviewed the documentation received by the department regarding Resident #1 (R1, see List of Confidential Names).

No deficiencies were cited.

An exit interview was conducted, and a copy to this report, List of Confidential Names, and Licensee's Rights (9058 01/16) were provided to the Executive Director by electronic mail. An email read receipt confirms the acceptance of these documents.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jonathan C PinedaTELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020
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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