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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602252
Report Date: 03/22/2023
Date Signed: 03/22/2023 05:09:03 PM


Document Has Been Signed on 03/22/2023 05:09 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:
03/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Siera NavasakTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Case Management - Other visit. LPA identified herself and was allowed entry into the facility by Staff, Lucita Credito. Administrator, Siera Navasak arrived during the visit.

During today's visit, a tour of the facility was conducted and residents were observed. There were no healthy and safety issues observed. No deficiencies were observed during the visit. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator, Siera Navasak whose signature below confirms receipt of these rights.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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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