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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602252
Report Date: 03/20/2023
Date Signed: 03/20/2023 01:36:31 PM


Document Has Been Signed on 03/20/2023 01:36 PM - 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:OCEANSIDE REST HOME IIFACILITY NUMBER:
374602252
ADMINISTRATOR:SIERA NAVASAKFACILITY TYPE:
740
ADDRESS:15 SHASTA COURTTELEPHONE:
(760) 722-8503
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 6DATE:
03/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Licensee Siera NavasakTIME COMPLETED:
01:39 PM
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Licensing Program Analysts (LPA) Dang Nguyen and Alyssa Ramirez conducted an unannounced Case Management Visit to observe the facility's physical plant. LPAs were welcomed by and identified themselves to Caregiver Lucy Credito. LPAs then met and discussed the purpose of the visit with Licensee Siera Navasak.

On 10-14-2022, the licensee submitted an LIC200 Application to the CCLD San Diego Regional Office (RO) to amend the facility's floor plan, by adding two (2) staff bedrooms and two (2) staff bathrooms.

On 03-06-2023, the local fire authority granted an updated fire clearance, showing the facility’s bedroom and bathroom additions were approved. There were no changes to the facility’s licensed capacity or non-ambulatory status.

During today’s visit, LPAs conducted a brief tour of the facility to view the bedroom and bathroom additions. Smoke and carbon monoxide alarms were working and the facility's fire extinguisher had been serviced within the last 12 months. Licensee's updated facility sketch/floor plan was also consistent with the current layout of the facility. LPAs observed no immediate health or safety issues. No deficiencies were cited.

This portion of the application process is complete. Pending CCLD management’s final review and approval, the licensee will be sent an updated license to reflect the new fire clearance.

An exit interview was conducted with Navasak, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2023
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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