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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603609
Report Date: 09/24/2021
Date Signed: 09/24/2021 02:56:26 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: 0DATE:
09/24/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:Glenn Gines, LicenseeTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Carmen Lopez, conducted an announced visit to verify the closure of the facility. LPA Lopez identified herself and was granted entry by Glenn Gines, Licensee. LPA stated the purpose of the visit and verified the closure with Glenn Gines, Licensee.

During the visit, LPA Lopez toured the facility and verified that there were no resident’s in care. All bedrooms previously occupied by resident’s were empty. LPA Lopez spoke with Licensee who confirmed the residents were moved by the resident’s family members. All residents were relocated, and the last resident was relocated on Thursday, July 15, 2021. LPA obtained the relocation information of the residents. During today’s visit the Licensee, surrendered the original license.

An exit interview was conducted with Glenn Gines, Licensee, and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided to Licensee Gines, 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: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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