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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603244
Report Date: 07/15/2024
Date Signed: 07/15/2024 10:52:05 AM

Document Has Been Signed on 07/15/2024 10:52 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SAILS JACK PINEFACILITY NUMBER:
374603244
ADMINISTRATOR/
DIRECTOR:		SILVIA DAVALOSFACILITY TYPE:
735
ADDRESS:5240 JACK PINE CTTELEPHONE:
(760) 547-7630
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 5CENSUS: 3DATE:
07/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Administrator Javier PelayoTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to verify closure of the facility. LPA was greeted by, identified herself to, and explained the purpose of the visit to Administrator Javier Pelayo.

On 5/10/2024, the facility submitted a closure notification to the Department with a closure date of 7/12/2024.

During today's visit, LPA toured the facility and observed that two of the five clients had been relocated to alternative placement and three clients remain at the facility. LPA verified with Administrator Pelayo the locations of the relocated clients. LPA provided guidance regarding notifying the Department when all clients have been relocated from the facility and the necessity of an additional visit to verify that the facility has closed. As of today's visit, the facility is still caring for clients and remains in operation.

No deficiencies were cited on today’s date. An exit interview was conducted with Administrator Javier Pelayo, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
Jennifer Lott
Rebecca A Ruiz
DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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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