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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603395
Report Date: 09/14/2021
Date Signed: 09/14/2021 03:42:05 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:SUNRISE ASSISTED LIVING AT LA JOLLAFACILITY NUMBER:
374603395
ADMINISTRATOR:RICHARDSON, PAULFACILITY TYPE:
740
ADDRESS:810 TURQUOISE STTELEPHONE:
(858) 488-4300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92109
CAPACITY:76CENSUS: 48DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Executive Director Paul RichardsonTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Executive Director Paul Richardson.

LPA conducted a brief tour of the facility and observed the clients in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, observed, and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, testing surveillance, screening protocols, and the use of personal protective equipment. No deficiencies were cited or observed on this date.

An exit interview was conducted with Executive Director Paul Richardson, to whom a copy of this report and the licensee appeal rights (LIC9058 01/16) were provided via E-mail.
SUPERVISOR'S NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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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