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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603190
Report Date: 05/21/2021
Date Signed: 05/21/2021 04:23:58 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:ACTIVCARE AT BRESSI RANCHFACILITY NUMBER:
374603190
ADMINISTRATOR:MCDONALD, JASONFACILITY TYPE:
740
ADDRESS:6255 NYGAARDTELEPHONE:
(760) 603-9999
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:80CENSUS: 45DATE:
05/21/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Jason McDonald- AdministratorTIME COMPLETED:
03:04 PM
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Licensing Program Analyst (LPA), Liliana Silveira and Licensing Program Manager (LPM) Denise Powell made an unannounced visit regarding an Incident Report received 05/14/21. LPA and LPM met with Administrator Jason McDonald, identified themselves and disclosed the purpose of their visit.

During today's visit, LPA and LPM toured the facility and conducted a health and safety check. No immediate health and safety concerns were observed and no deficiencies were cited. LPA and LPM also interviewed the Administrator, residents and collected resident records.

An exit interview was conducted and a copy of Licensee's Rights (LIC 9098 01/16) along with a copy of this report were emailed to Administrator Jason McDonald, whose signature below confirms receipt.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
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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