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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601239
Report Date: 06/15/2021
Date Signed: 06/16/2021 09:50:53 AM

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:SUNBEAM HOME CARE #2FACILITY NUMBER:
374601239
ADMINISTRATOR:DONNALYN M.PURIFICACIONFACILITY TYPE:
740
ADDRESS:4670 TWAIN AVENUETELEPHONE:
(619) 255-8326
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:6CENSUS: 3DATE:
06/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Alfredo Pacleb and Maria PaclebTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA identified himself and discussed the purpose of the visit to caregivers Alfredo Pacleb and Maria Pacleb. All staff encountered have a current criminal record clearance.

LPA conducted a brief tour of the facility and observed the residents in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, and evaluated and observed the facility's implementation of their COVID-19 Mitigation Plan to include disinfection and screening protocols and the use of personal protective equipment. No deficiencies were cited on this date.

An exit interview was conducted with the Paclebs. A copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail to the facility's administrator.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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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