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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603609
Report Date: 05/11/2021
Date Signed: 05/11/2021 07:42:08 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:VISTA SUNRISE ELDER CAREFACILITY NUMBER:
374603609
ADMINISTRATOR:GLENN GINESFACILITY TYPE:
740
ADDRESS:1904 CRESTHAVEN DRIVETELEPHONE:
(760) 639-2985
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:6CENSUS: 3DATE:
05/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:52 PM
MET WITH:Glen Gines, AdministratorTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA), Carmen Lopez conducted an unannounced virtual Case Management Visit. LPA spoke with Glen Gines, Administrator, via FaceTime application. LPA identified herself to Administrator Gines and explained the purpose of the call.

The virtual visit was in response to the facility’s Mitigation Plan. LPA reviewed the elements of the plan with Administrator Gines and conducted a virtual tour. LPA observed proper mitigation protocols were in place and PPE was observed at the facility.

No deficiencies were noted during today’s visit.

An exit interview was conducted via telephone and a copy of the report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Glen Gines, Administrator, via email. An electronic email receipt confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021
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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