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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603395
Report Date: 08/11/2022
Date Signed: 08/11/2022 02:42:23 PM


Document Has Been Signed on 08/11/2022 02:42 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
SO. CAL AC/SC, 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: 50DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Taira Leon, Director of SalesTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified himself to, and explained the purpose of the visit to Director of Sales, Taira Leon. LPA confirmed that all staff present have a current criminal record clearance.

LPA, accompanied by Director, Leon, Maintenance Director, Ramsey Fanni and Resident Care Director, Rocio Alvarez (call in), reviewed and discussed the facility's written Infection Control Plan which was submitted to CCLD in July 2022. LPA conducted a brief tour of the facility and observed residents in care.

In accordance with the Department’s Infection Control, LPA 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 ( PPE). Director, Leon stated that the facility is fully staffed at this time. LPA observed facility PPE supplies which were adequate. Director, Fanni said the facility has no PPE supply needs at this time. Director, Fanni also advised LPA that all employees have received fit-testing for N-95 masks and are retested annually.

No deficiencies were cited or observed on this date.

An exit interview was conducted with Director, Leon and a copy of this report and the licensee appeal rights (LIC9058 01/16) were provided via hard copy.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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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