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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601560
Report Date: 03/05/2021
Date Signed: 03/05/2021 05:38:50 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:GLENBROOK ASSISTED LIVINGFACILITY NUMBER:
374601560
ADMINISTRATOR:HARNESS, SADIEFACILITY TYPE:
740
ADDRESS:1950 CALLE BARCELONATELEPHONE:
(760) 704-6800
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:95CENSUS: 69DATE:
03/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Executive Director, Sadie HarnessTIME COMPLETED:
02:00 PM
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Licensing Program Manager (LPM), Alexandre Vo, conducted an unannounced Case Management visit due to an incident report received at the San Diego Regional Office on March 3, 2021. LPM met with Executive Director, Sadie Harness, identified himself, and stated the purpose of the visit.

During today's visit, LPM conducted a brief tour of the facility, a health and safety check of the residents, and obtained records. At this time, further investigation is necessary and future visits may be required to determine the outcome. No deficiencies were cited during the visit.

An exit interview was conducted with the Executive Director. A copy of this report and Licensee's Rights (9058 01/16) were provided to the Executive Director by electronic mail. An e-mail receipt confirms the acknowledgement of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021
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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