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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601134
Report Date: 06/26/2023
Date Signed: 06/27/2023 11:00:09 AM


Document Has Been Signed on 06/27/2023 11:00 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:SUNRISE AT LA COSTAFACILITY NUMBER:
374601134
ADMINISTRATOR:ERIKA CASTILEFACILITY TYPE:
740
ADDRESS:7020 MANZANITA STTELEPHONE:
(760) 930-0060
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:120CENSUS: 65DATE:
06/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Executive Director Erika CastileTIME COMPLETED:
04:00 PM
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Licensing Program Manager (LPM) Simon Jacob conducted a case management visit to investigative the circumstances surrounding a Death Report received on June 23, 2023. LPA met with Executive Director Erika Castile and discussed the purpose of the visit.

LPM reviewed R1's facility file, collected relevant records, and conducted interviews. The Death Certificate and Coroner's Report were also requested during the visit.

No deficiencies were issued during the visit.

An exit interview was conducted with Executive Director Erika Castile and a copy of this report and Licensee Rights (LIC9058 01/2016) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: Kimberly LyonTELEPHONE: (619) 767-2300
LICENSING EVALUATOR NAME: Simon JacobTELEPHONE: (619) 767-2306)
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2023
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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